職災移工的重建經驗：訪談研究

Abstract

研究背景與目的：臺灣移工人數逐年上升，截至2024年底已超過82萬人。移工主要來自東南亞國家，從事高危險性的工作，職災發生率高於本國籍勞工。我國於2022年5月1日實施勞工職業災害保險與保護法，整合職災保險、重建、預防，並將產業移工、社福移工與境內聘僱漁工納入保障範圍。職災重建服務分為醫療復健、社會復健、職能復健和職業重建，以協助職災勞工順利恢復工作能力並重回職場。然而目前缺乏移工利用重建服務的研究，無法瞭解移工在勞工職業災害保險與保護法之保障範圍下，實際獲得重建服務的經驗與可能困境。本研究旨在探討職災移工在四大重建項目的服務利用情形，以及過程中面臨的障礙，並瞭解他們與不同利害關係人的互動經驗，以及此互動經驗對其重建服務利用的影響。

研究方法：本研究於2024年6至10月間進行深度訪談，受訪對象為2022年5月1日後發生職災之移工。透過職業醫學專科醫師、NGO、縣市政府勞工局等單位轉介，總共訪問20名職災移工；依其產業類別，有產業移工14人、社福移工4人、境內聘僱漁工2人；依國籍區分，有越南籍8人、印尼籍9人、菲律賓籍3人。本研究使用架構分析法分析訪談內容，將資料依四大重建項目作主題歸納，並探討利害關係人的影響。

研究結果：在醫療復健方面，研究發現移工對災保法認知缺乏，加上未獲得雇主的適當協助，導致部分移工有延誤就醫或無法獲得適當治療之情形；醫療院所通譯資源不足，使移工在描述病情和理解醫囑時面臨困難；醫療機構整合與轉介存在漏洞，使部分移工無法進入專業的職災醫療體系。在社會復健方面，研究發現轉介至社會復健服務存在漏洞，部分移工因未被轉介而無法獲得專業服務，而仲介及民間組織在此階段作為專業服務人員的替代；申請災保給付時面臨權力不對等，包括制度過度依賴雇主配合，及申請文件僅有中文版本；心理支持資源轉介不足，造成未有任何受訪者接受專業心理健康服務；部分政府部門人員態度消極，無法提供移工合適的資訊與協助。在職能復健方面，本研究發現移工復工與否大多由雇主主觀判斷並作決定，導致部分移工在尚未完全康復之下即返回工作崗位；職能強化訓練過程缺乏陪同人力，使移工無法定期接受復健訓練。在職業重建方面，本研究也發現部分符合轉換雇主條件的移工，缺乏協助重返新職場的支持。

結論：本研究發現職災移工在災保法重建服務利用過程中面臨語言障礙、權力不對等、服務轉介斷裂與制度性歧視等挑戰，此外，各重建服務間存在銜接不佳問題，而利害關係人的態度影響移工使用服務資源。建議未來研究可長期追蹤職災移工從傷病發生到復工的完整歷程，透過多時間點的訪談深入了解職災移工復工過程中的動態變化，並觀察制度的長期運作情況，定期評估政策調整的實際成效。

Background and Objectives: The number of migrant workers in Taiwan had reached 820,000 by the end of 2024. They predominantly come from Southeast Asian countries and work in high-risk occupations with elevated occupational injury rates compared to local workers. The Occupational Accident Insurance and Protection Act was implemented in May 2022, integrating insurance, rehabilitation, and prevention services while extending coverage to all categories of migrant workers. Rehabilitation services encompass medical, social, functional, and vocational domains to facilitate injured workers' recovery and workplace reintegration. However, limited research exists on migrant workers' utilization of these services, creating a knowledge gap regarding their experiences under the new legislation. This study examined the post-injury experiences of migrant workers, focusing on their utilization of the four types of rehabilitation services, the barriers to access, their interactions with stakeholders, and the influences of the interactions on service utilization.

Methods: We interviewed 20 migrant workers during June and October 2024. Eligible participants were migrant workers who had experienced work-related injuries after May 1, 2022, the date the new legislature implemented. Participants were recruited through occupational medicine specialists, non-governmental organizations, and the labor bureaus of city or county governments. A total of 20 migrant workers were interviewed, including 14 manufacturing workers, 4 domestic care workers, and 2 fishermen. There were 8 Vietnamese, 9 Indonesians, and 3 Filipinos. Framework analysis was employed to examine workers’ experiences in the four types of rehabilitation services and the interactions with stakeholders.

Results: In medical rehabilitation, migrant workers demonstrated limited knowledge of the Act and received inadequate employer support, resulting in delayed treatment access or inability to obtain appropriate treatment. Insufficient interpretation services in healthcare settings impeded effective communication when describing symptoms and understanding medical instructions, while gaps in medical institution integration and referral systems prevented some migrant workers from accessing specialized occupational injury healthcare systems. In social rehabilitation, systematic referral deficiencies left some workers without professional services, with employment agencies and NGOs functioning as substitutes for professional service personnel. Power asymmetries complicated insurance benefit applications, exacerbated by policy overreliance on employer cooperation and Chinese-only documentation. No participants reported accessing professional mental health services despite having psychological support needs, and some government personnel exhibited passive attitudes, failing to provide the information and assistance migrant workers needed. In functional rehabilitation, migrant workers' return to work was often determined by employers' subjective judgment, potentially leading to premature return to work before full recovery. Inadequate accompanying personnel support hindered regular participation in strengthening training and rehabilitation exercises. In vocational rehabilitation, migrant workers who met the conditions for employer transfer lacked support for returning to new workplaces.

Conclusion: This study found that injured migrant workers face challenges including language barriers, power imbalances, service referral disruptions, and discrimination and harassment in their utilization of rehabilitation services under the Labor Occupational Accident Insurance and Protection Act. Coordination problems exist among various rehabilitation services, and interactions with stakeholders demonstrate that stakeholder attitudes influence service experiences.