If you fall sick or are injured due to a traffic accident or the actions of a third party
You can use health insurance if you fall sick or are injured due to a traffic accident (including a bicycle accident) or the harmful actions of a third party, but you must first obtain the Health Insurance Society’s consent to use your health insurance card. After obtaining consent, promptly submit a Notification of Injury or Sickness due to a Traffic Accident/Third-party Act.
- *The copayment rate for injury or illness caused by the actions of a third party is 20%, even for persons aged 70–74 to whom the 10% copayment rate applies as an exceptional measure.
Be sure to notify the Health Insurance Society
You can be treated under health insurance if you fall sick or are injured due to a traffic accident or the actions of a third 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.
- *The copayment rate for injury or sickness caused by the actions of a third party is 20%, even for persons aged 70-74 to whom the 10% copayment rate applies as an exceptional measure.
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.
- STEP4Notifying the Health Insurance Society
Promptly contact and submit a notification to the Health Insurance Society.
- STEP5Be 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:
- If you were injured in an accident involving bicycles only
- 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 are injured while commuting to or from work or while on the job, the applicable system is Worker’s Accident Compensation Insurance, not health insurance. Check with the staff responsible at your establishment.
- *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).
- Be sure to contact the Health Insurance Society if treatment for the accident ends or is cancelled.
- The documents use the terms “victim” and “party responsible.” Regardless of the extent of the actual negligence, fill out the forms designating the injured insured person (or dependent) as the victim.