勞工職業災害保險復健給付法制之研究 - 政大學術集成
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(2) 摘. 要. 本文旨在透過相關國際基準探討個人因身心因素被迫離開工作職場時， 在職災保險中透過復健手段，給予個人適當協助，使之重返職場之必要性及 有關給付基準，並再透過其他國家具體實踐狀況，來作為我國往後制度建置 可能參考。 若由國際勞工組織相關基準來看，相關公約已明確表示社會保險提供復 健給付，其中亦包含職災保險，且服務不限職業重建，凡可協助個人重返職 場者皆可，另若屬職業重建者，則可採取直接於社會保險中提供，或透過提 供原有職業重建服務各項支援方式來達到要求。在具體實踐上，於日本法上 可見復建服務亦可透過建立專門醫療院所並輔以部分重返職場支援服務，透 過賦予原有醫療給付更積極功能，以此促進職災勞工回到職場，另透過對美 國與日本制度的觀察，亦可發現在職業重建給付部分，除可由社會保險自行 提供外，另可透過向既有職業重建服務提供經費支持或合作，以之促進個人 對職業重建服務使用，尤以若從美日發展來看，尚可見無論是否嘗試自行建 立相關給付，為提供職業重建服務，與原職業重建服務連結實屬必要。. 立. 政 治 大. ‧ 國. 學. ‧. 若觀我國作法，我國勞工保險內的職災保險並未提供復健給付，即便勞 工保險仍保有醫療給付，但此給付亦並未以協助重返職場為目的。另在與職 災保險相關者，我國尚利用勞保財務透過職業災害勞工保護法建立相關服務。 惟該法雖設有復健相關服務，然而其中許多給付項目仍屬缺乏，且相關體系 也缺乏如美日般與原有身心障礙者職業重建服務間的聯繫。據此，參前述外 國法作法，吾人自得嘗試藉由建立專門醫療機構，藉由原醫療給付促進職災 勞工回到職場，另亦可嘗試透過對既有身心障礙者職業重建服務提供經費補 al v i 助或建立合作方式，來以之完善職災復健給付；至於在後續其他普通事故年 n Ch engchi U 金保險復健給付上，除上開日本專門醫療機構亦可嘗試外，另亦可參照美國 社會安全制度作法，同樣應先嘗試透過財政補助方式，向身心障礙者職業重 建體系提供經費支持，由此提供給付受領者職業重建服務，若此後因原有體 系服務量不足以提供給付受領者服務，則或可再考慮透過引進其他公私立機 構構成之職業重建機構，以此來擴大服務可及性。. n. er. io. sit. y. Nat. 關鍵字：職災保險、職業災害勞工保護法、社會安全法、勞動者災害補償保 險法、復健給付、現金給付. i. DOI:10.6814/THE.NCCU.LAW.015.2018.F10.
(3) 目次 摘要 ····································································································································i 目次 ···································································································································ii 表次 ···································································································································v 圖次 ··································································································································vi 第一章 緒論 ····················································································································1 第一節 研究動機與目的 ························································································1 第二節 研究範圍 ····································································································1 第三節 研究方法 ····································································································2 第四節 論文架構 ····································································································3 第五節 文獻回顧 ····································································································4 第二章 復健給付定義、範圍與相關國際基準 ····························································8 第一節 概論 ············································································································8 第二節 國際勞工組織相關基準 ··········································································10 第一項 復健基準的起源 ··············································································10 第二項 國勞對社會保險上的復健服務要求 ··············································11 第三項 國勞對復健服務規範的展開與具體基準 ······································13 第三節 聯合國相關基準 ······················································································19. 立. 政 治 大. ‧. ‧ 國. 學. 第一項 緒論 ··································································································19. n. al. er. io. sit. y. Nat. 第二項 復健的目的、定義與範圍 ······························································21 第三項 復健的基本原則 ··············································································22 第四項 復健服務其餘應注意事項 ······························································25 第四節 歐洲相關基準 ··························································································25 第一項 概說 ··································································································25 第二項 第（92）6 號「身心障礙者復健完整政策」建議書 ···················31 第五節 小結 ··········································································································35 第三章 我國相關復健給付法制現況 ··········································································38 第一節 我國職災保險給付實施現況 ··································································38 第一項 勞工保險條例職災保險給付現況 ··················································38 第二節 年金保險、職域年金與其他社會保險給付實施現況 ··························39 第一項 勞工保險普通失能給付 ··································································39 第二項 公教人員年金保險與職域年金法制 ··············································39 第三項 軍人年金保險與職域年金法制 ······················································42. Ch. engchi. i n U. v. 第四項 其他社會保險給付實施現況 ··························································44 第五項 小結 ··································································································47 第三節 職業災害勞工保護法 ··············································································47 第一項 立法概說 ··························································································47 ii. DOI:10.6814/THE.NCCU.LAW.015.2018.F10.
(4) 第二項 職業重建服務之提供 ······································································49 第三項 職業災害勞工個案主動服務計畫 ··················································59 第四項 職業傷病管理服務中心與職業傷病防治中心 ······························61 第四節 勞工職業災害保險法草案 ······································································62 第五節 依相關國際基準檢視台灣制度現況 ······················································63 第一項 提供促進重返工作之復健給付或職業重建服務 ··························64 第二項 提供職業輔導、職業訓練與職業安置等服務並由專門人員提供 ························································································································64 第三項 以現有設施並以社區為基礎維持服務可及性 ······························64 第四項 及早、依個人需求提供服務並依需求提供輔具及其他必要輔助 ························································································································65 第五項 促進個人及其家屬參與及決定 ······················································65 第六節 小結 ··········································································································65 第四章 美國相關復健給付法制現況 ··········································································67 第一節 緒論 ··········································································································67 第二節 給付創設前制度發展 ··············································································67 第一項 1930 年代社會安全制度討論··························································67 第二項 1940 年代社會安全制度討論··························································69 第三項 1950 年代社會安全制度討論··························································73. 立. 政 治 大. ‧. ‧ 國. 學. 第三節 1956 年社會安全法··················································································75. n. al. er. io. sit. y. Nat. 第一項 1956 年社會安全法修正··································································75 第二項 小結 ··································································································77 第四節 導入後的復健給付發展 ··········································································78 第一項 緒論 ··································································································78 第二項 社會安全法對復健給付之經費援助 ··············································79 第三項 工作券及工作動機改善法的實施 ··················································82 第五節 工作券制度介紹 ······················································································84 第一項 緒論 ··································································································84 第二項 工作券計畫管理組織 ······································································85 第三項 雇用網絡（Employment Network, EN） ·········································86 第四項 工作券的使用 ··················································································87 第五項 工作券計畫政策執行效果 ····························································109 第六節 依相關國際基準檢視美國制度現況 ····················································118 第一項 提供促進重返工作之復健給付或職業重建服務 ························118. Ch. engchi. i n U. v. 第二項 提供職業輔導、職業訓練與職業安置等服務並由專門人員提供 ······················································································································118 第三項 以現有設施並以社區為基礎維持服務可及性 ····························118 第四項 及早、依個人需求提供服務並依需求提供輔具及其他必要輔助 iii. DOI:10.6814/THE.NCCU.LAW.015.2018.F10.
(5) ······················································································································118 第五項 促進個人及其家屬參與及決定 ····················································119 第七節 小結 ········································································································119 第五章 日本相關復健給付法制現況 ········································································122 第一節 緒論 ········································································································122 第二節 厚生年金及國民年金上復健給付發展狀況 ········································122 第一項 二年金保險復健給付早期發展 ····················································122 第二項 小結 ································································································124 第三節 勞動者災害補償保險復健給付 ····························································124 第一項 職災給付立法發展 ········································································125 第二項 勞動者災害保險立法概況 ····························································126 第三項 社會復歸事業的起始 ····································································127 第四項 現行體制介紹 ················································································129 第五項 社會復歸事業實施現況 ································································147 第四節 依相關國際基準檢視日本制度現況 ····················································149 第一項 提供促進重返工作之復健給付或職業重建服務 ························149 第二項 提供職業輔導、職業訓練與職業安置等服務並由專門人員提供. 立. 政 治 大. ‧ 國. 學. ‧. ······················································································································149 第三項 以現有設施並以社區為基礎維持服務可及性 ····························149 第四項 及早、依個人需求提供服務並依需求提供輔具及其他必要輔助. sit. y. Nat. ······················································································································150 第五項 促進個人及其家屬參與及決定 ····················································150. n. al. er. io. 第五節 小結 ········································································································150 第六章 結論 ················································································································152 參考文獻 ······················································································································155. Ch. engchi. i n U. v. iv. DOI:10.6814/THE.NCCU.LAW.015.2018.F10.
(6) 表次 表 3-1 職業重建服務補助類別與申請資格…………………………………………46 表 3-2 服務提供單位與提供服務項目一覽…………………………………………50 表 3-3 各年度計畫補助總額…………………………………………………………52 表 3-4 各年度職業重建計劃受補助單位數…………………………………………53 表 3-5 歷年服務項目補助申請數量…………………………………………………53 表 3-6 歷年服務項目補助申請數量（續）…………………………………………54. 立. 政 治 大. ‧. ‧ 國. 學. n. er. io. sit. y. Nat. al. Ch. engchi. i n U. v. v. DOI:10.6814/THE.NCCU.LAW.015.2018.F10.
(7) 圖次 圖 5-1 職災醫院的職業復歸支援服務………………………………………………125 圖 5-2 治療就勞兩立支援模型事業架構圖…………………………………………126 圖 5-3 兩立支援協服務示意圖………………………………………………………128 圖 5-4 產業保健綜合支援中心職業生活兩立支援服務順序圖……………………130 圖 5-5 吉備高原醫療復健中心功能示意圖…………………………………………131. 立. 政 治 大. ‧. ‧ 國. 學. n. er. io. sit. y. Nat. al. Ch. engchi. i n U. v. vi. DOI:10.6814/THE.NCCU.LAW.015.2018.F10.
(8) 第一章 緒論 第一節 研究動機與目的 投入就業市場取得工作並受有可供生活的薪資，此為個人現今身處社會中的 重要大事，蓋工作的意義不僅是透過取得薪資而使生活不至於匱乏，另一方面，透 過工作更可發展與增進個人智識、精神與肉體上等能力並藉此實現自我，同時更可 藉由在工作上與他人（如同事）互動，進而產生共同直接連帶關係並感受個人生存 意義。若從這樣的觀點出發，為了達成個人參與社會運作的基本要件，取得工作或 可說已成為一件不可或缺的事。 然而在一些情形底下個人可能無法（再）進入就業市場，並且以因身心因素被 迫離開工作或始終無法投入就業市場，最屬常態。其中，相關身心因素可略分作因 後天上，即因職業災害或其他傷病事故被迫離開職場或無法進入職場之個人，或因 先天上，即因與生俱來之因素而有就業困難者。為了促進前揭對象可（再）投入就 業市場，給予適當協助服務（給付） ，使其得以回復、維持甚至改善各方面機能或 有必要，就此，可供使用的給付措施可能即為「復健（Rehabilitation）」服務。而復 健本身係指協助個人維持、改善、提升各方面能力之各項服務，在社會安全制度中， 我們自得透過目前的健康保險或相關就業促進法制來提供個人需要的復健服務. 立. 政 治 大. ‧ 國. 學. ‧. （如醫學復健及職業重建等服務） ，然而另一方面，在社會保險中，尤其是主要用 以填補個人喪失所得能力時之所得風險的社會保險類型，如年金保險與職業災害 保險等，此等社會保險除了以是否保有工作能力作為給付要件而將被保險人一分 為二外，是否更有應藉由復健給付協助個人維持、改善、提升工作能力，並以復健 給付作為社會生活（尤其是職場）與現金給付間的緩衝地帶，或扮演協助被保險人 朝向保有工作能力的積極角色？又當肯認復健給付在社會保險中具有提供必要性 時，則提供復健給付時的具體實踐方式究竟為何，似乎亦為另一可供開展討論之重 點。. n. er. io. sit. y. Nat. al. Ch. engchi. i n U. v. 基於前揭研究動機，本文研究目的，將在於嘗試探詢社會保險中納入復健給付 之必要性，並在相關答案為肯定時在進一步探詢制度建構可能形式。在此本文將試 圖透過國際上相關基準發展及其他國家的制度現況來探求上述問題可能答案。並 期待透過上開討論後，本文能藉由目前國際相關基準來建構復健給付之基本原則； 而在具體制度建構上，則希望透過比較法形式，藉由外國法制與我國法制之介紹及 比較，探討我國社會保險復健給付之未來可能方向。. 第二節 研究範圍 雖然相關討論可及於以提供現金給付為主的所有社會保險，然而本文研究範 圍主要將聚焦在職業災害保險部分，故將以我國「勞工保險條例」上的「職業災害 1. DOI:10.6814/THE.NCCU.LAW.015.2018.F10.
(9) 事故」為重，又為了解各該社會保險目前相關給付現況，是故「勞工保險條例」、 「公教人員保險法」及「軍人保險條例」 ，也會包含在本文檢視範圍內，另也會一 併檢視對於公教人員的職域年金規範，如「公務人員退休資遣撫卹法」 、 「公立學校 教職員退休資遣撫卹條例」 、 「軍人撫卹條例」及「陸海空軍軍官士官服役條例」等 規定。在外國法部分，本文將以美國「社會安全法（Social Security Act）」上相關復 健給付規定作為研究對象，並因我國 2014 年「勞工職業災害保險法」相關草案已 提及有關制度亦有參考日本經驗1，故在此本文尚將一併觀察日本「勞動者災害補 償保險法」上之相關規定。 另在此等職災保險中，本文主要將以為了避免個人在達到退休年齡前，必須因 喪失工作能力致長時間或終身倚靠現金給付而所施加之復健給付為討論範圍，而 對此因此等社會保險係以工作能力喪失與否作為提供現金給付之前提，是故在此 的復健給付討論上，復健也將係指為了促使個人處於無須倚靠現金給付之工作能 力水準，而用以協助個人維持既有工作能力以避免完全喪失，或在無法回任原工作 或工作能力有所減損致就業有困難時，用以改善及提升工作能力等給付。. 立. 政 治 大. ‧. ‧ 國. 學. 又在復健給付的適用對象上，雖然想像上身心障礙者固然可能出現喪失工作 能力之情形，而可能成為復健給付的主要使用者，然而即便如此，身心障礙者也不 當然與喪失工作能力劃上等號。惟不可否認地，在部分復健給付中，如職業重建， 該等給付在討論及提供上即時常以身心障礙者作為適用對象2，然而若在喪失工作. al. er. io. sit. y. Nat. 能力脈絡下討論社會保險復健給付，則因社會保險中的復健在此目的下給付將不 僅限於職業重建，且身心障礙者亦非當然喪失工作能力已如前述，從而相關給付適 用對象似自不僅限於身心障礙者，對此，凡是對因喪失工作能力而可能落入必須長 期間或終身倚靠現金給付之被保險人所提供之復健給付，皆將為本文討論社會保 險中復健給付時被論及。. n. v i n Ch 另外，如同前述，為透過觀察目前國際有關基準，了解目前國際社會所建立之 engchi U 社會保險復健給付原則，是以本文也會對目前國際上，如國際勞工組織公約及建議 書、聯合國相關宣言與公約、及歐洲聯合組織相關規範進行討論。. 第三節 研究方法 研究方法上，本文將透過傳統的文獻分析法，從各類專書、期刊文章、研討會 文章、社會團體或公部門出版品、報紙及網路文章作為分析客體，另亦採比較研究. 1. 立法院第 8 屆第 6 會期第 10 次會議議案關係文書院總第 468 號，頁 120，立. 法院，2014 年。 Active Labor Market Policies in Europe: performance and Perspectives, Jochen Kluve et al., Springer, p.28, 2007; Analytical Paper: Disability and Labour Market Integration, Ágota Scharle, Márton Csillag, Budapest Institute, p.10, 2016. 2 2. DOI:10.6814/THE.NCCU.LAW.015.2018.F10.
(10) 法，主要針對我國與美國及日本相關復健給付法制進行研究。. 第四節 論文架構 本文共分成七大章節，前二章屬概論性質，後五章則屬各論性質。此除第一章 用以介紹本文動機、目的、研究範圍、研究方法與章節架構外，其餘各章節內容安 排則如下所述：. 第二章 本章將分作二部分，第一部分將論及復健起源，並再論及復健通常類型、定義 以及復健通常相應指涉範圍。第二部分則為復健相關法制之國際基準。在此國際基 準將分為三部分，而其中因國際勞工組織公約對社會保險復健給付有較明確的揭 示，故在此將以國際勞工組織公約與建議書為主，並分別再輔以聯合國相關宣言、 規則與公約，以及歐洲相關聯合組織之建議書規範，本文擬透過目前國際上相關規 範所揭示之基準，以此了解復健於社會保險上的基本原則及架構。. 立. 第三章. 政 治 大. ‧. ‧ 國. 學. 本章節將區分為三大部分，第一部份將對我國職災保險制度進行檢視，並於當 中檢驗我國相關法制是否有與復健給付相關之規定，另在此部分，也將一併檢視我 國以提供現金給付為主之社會保險（即年金保險）與其他社會保險。至於第二部分，. sit. n. al. er. io. 第四章. y. Nat. 則因我國職業災害勞工保護法有以勞保職業災害保險作為財源辦理相關服務，故 在此本文也將對該法所提供之復健相關給付進行介紹。至於第三部分，則會以前章 所得國際基準對我國制度進行檢視。. Ch. i n U. v. 自第四章起將介紹美國相關給付制度現況，在此將聚焦到該國的社會安全法。 其中，因該法上復健給付相關發展與失能給付形成間具密不可分的關係，故在一開 始將概略回顧失能給付建立過程，以此了解復健給付對該國社會安全法發展之意 義。此後，因目前美國社會安全法復健給付係以向給付受領者發放工作券之「工作 券計畫」來實施服務，故在本文介紹美國法制時，將會以此一工作券計畫作為介紹 重點，並於最後將述及目前制度實施狀況，另亦將以國際基準進行檢視。. engchi. 第五章 自第五章起將介紹日本相關給付制度現況。本章將以「勞動者災害補償保險法」 上的復健體系作為介紹重點，並且因該法與復健相關之服務，係在社會復歸事業下， 由獨立行政法人勞動者健康安全機構所設立管理之職災醫院、醫學復健中心、綜合 脊髓損傷中心及產業保健綜合支援中心負責提供服務，故在此本文首先將回顧日 本職災保險下社會復歸事業的形成過程，此後則聚焦在由勞動者健康安全機構所 構成的服務機構架構，並述及目前制度實施狀況，另亦將以國際基準進行檢視。 3. DOI:10.6814/THE.NCCU.LAW.015.2018.F10.
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