If you become sick or are injured due to the actions of another party
In principle, the party responsible for the accident must pay medical care costs for an injury attributable to the actions of another party, such as traffic accidents.
However, you can use your health insurance to receive treatment, as long as the accident did not take place on the job or while commuting to or from work. In such cases, notify the Health Insurance Association as soon as possible.
- Be sure to notify the Health Insurance Association
- If you have been in a traffic accident
- Injury due to the actions of another party
- If the cause is a workplace accident
Be sure to notify the Health Insurance Association
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 Association 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 Association as soon as possible. In response, the Association will notify you in writing of the documents you need to submit and other information. Please complete the relevant procedures promptly.
This notification must be submitted even in cases involving significant error on your part or cases in which you ride in a family member’s car.
You cannot use health insurance for accidents that involve legal violations, including criminal actions, drunk driving, or driving without a license, or for accidents resulting from deliberate intent.
You cannot use health insurance if you have already received the cost of treatment from the party responsible for the accident.
Although cases such as solo accidents (not involving any other parties) and attempted suicide are not third-party actions, the notification must be submitted to receive insurance benefits.
Additionally, submit the notification in cases of bicycle or motorcycle accidents.
If you have been in a traffic accident
- Remain calm
In cases of shock, you may lose the ability to make calm judgments. React as calmly as possible.
- Check the identity of the party responsible
Check matters such as the license plate no., driver's license, and vehicle inspection certificate.
- Notify the police
Be sure to notify the police, no matter how small the accident.
In certain cases, you may not be able to claim damages unless the accident is officially handled as an accident involving injury. For this reason, be sure to notify the police.
- Be 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 Association 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).
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