If you become sick or are injured due to the actions of another party
You can undergo treatment under the health insurance system for sickness or injury due to the actions of another party, as in the case of a traffic accident. However, in such cases submit the Notification of Injury or Sickness due to a Third-party Act as soon as possible.
Be sure to notify the Health Insurance Society
You can undergo treatment under the health insurance system for sickness or injury due to the actions of another party. However, in such cases the Health Insurance Society merely pays up front on a temporary basis, the medical care costs that the party responsible for the accident must pay. The Society will bill that party for these costs later.
For this reason, when using health insurance for treatment in such cases, notify the Health Insurance Society and submit the Notification of Injury or Sickness due to a Third-party Act and other necessary documents as soon as possible.
Who pays medical care costs in the event of a traffic accident?
Use the Yes/No chart below to determine who is responsible for paying medical care costs in the event of a traffic accident.
If you have been in a traffic accident
- STEP1Remain calm
In cases of shock, you may lose the ability to make calm judgments. React as calmly as possible. - STEP2Check the identity of the party responsible
Check matters such as the license plate no., driver's license, and vehicle inspection certificate. - STEP3Notify the police
Be sure to notify the police, no matter how small the accident. - STEP4Be cautious about reaching a settlement
If you waive some of your rights to claim compensation for damages by reaching a settlement with the party responsible, you may be unable to receive the corresponding health insurance benefits. To avoid cases such as inability to use health insurance when you need medical care later for residual effects or other complications, consult with the Health Insurance Society before reaching any settlement.
Injury due to the actions of another party
While most cases of injury due to the actions of another party involve auto accidents, the following cases also are due to the actions of another party:
- Injury due to defective equipment at a school, supermarket, or other facility
- Injury caused by another's dog or other type of pet
- Injury due to inappropriate force or an act of violence
- Food poisoning at a restaurant or other establishment
If the cause is a workplace accident
If you become sick or are injured due to the actions of another party in the workplace or while commuting, Worker's Accident Compensation Insurance applies instead of health insurance. Check with the person responsible at your establishment for more information.
- *When even illnesses and injuries on-the-job are not targeted for benefits of the Worker's Accident Compensation Insurance, benefits of the health insurance are provided except the duties as the officer of the corporation (except for a corporation less than five employees).
A request from the Health Insurance Society
The Health Insurance Society inspects medical cost details (Rezepts) sent from medical care institutions as part of its efforts to rationalize medical care costs and to ensure the fair and appropriate use of precious insurance premiums collected from insured persons. It also sends letters of inquiry to confirm various matters: for example, whether a traumatic injury was due to the actions of a third party in the event of a traffic accident and similar cases or qualifies as a workplace accident or accident that occurred while commuting.
To further rationalize medical care costs, as part of this inspection process, the Society works with outside experts to make inquiries into the causes of traumatic injury.
This means you may receive written inquiries from Taisho Audit Inc., our partner, to confirm the status of your traumatic injury. If so, we ask that you assist us by responding promptly. We apologize for any inconvenience this may entail.
You may be contacted by Taisho Audit if this inquiry determines that the injury was attributable to the actions of a third party. This inquiry is not a demand for payment of medical care costs or other costs. In light of the flow of processing of Rezepts, the inquiry will take place two to three months after receipt of the Rezept from the medical care institution.
Contact the Health Insurance Society if you are involved in a traffic accident
Medical care costs for injuries due to the actions of third parties like traffic accidents are generally paid by the party responsible for the accident. However, as long as the accident was not a workplace accident or an accident that occurred during your commute, you can use health insurance to receive treatment. In such cases, the Health Insurance Society will pay medical care costs up front on a temporary basis and later bill the party responsible (or his or her insurance company) for these costs.
You will need to submit the Notification of Injury or Sickness due to a Third-party Act in the event of such an accident. Your cooperation is appreciated.