Covering work related injuries and illness: Workers' accident compensation insurance

photo by pmcinsurance

While you are working in Japan, you may unfortunately get injured or sick due to an accident caused by work. In such a case, you normally need a medical attention. But did you know that Health Insurance does not cover medical costs for such injuries and illnesses? Instead of Health Insurance, Workers’ accident compensation insurance (Rosai hoken) provide coverage for work-related injuries and illnesses. This is very important to support injured workers’ living and protect employers from huge liability to compensate detriments occurred.

About Workers’ accident compensation insurance (Rosai hoken)

Workers’ accident compensation insurance is designed to benefit workers, though, they never have to pay insurance tax, because it is employers’ responsibility to provide their employees this coverage and pay insurance premiums. As a general rule, an employer is obliged to compensate detriments such as medical costs or economic loss caused by a work-related accident. The government imposes obligation on employers that employ one or more workers to have workers’ accident compensation insurance, because such compensations often become excessively expensive. Workers’ accident compensation insurance pays benefits including wage replacement, medical benefits, care costs assistance, disability pension and funeral expenses benefit. Note that, some employees in agricultural forestry industries and fisheries are not mandated to have Workers’ accident compensation insurance. Also, public workers are insured by the insurance other than Workers’ accident compensation insurance.

※Workers’ accident compensation insurance is to be contracted under employer’s name, but claims should be made by employees.

Eligibility criteria of Workers’ accident compensation insurance

To be covered by Workers’ accident compensation insurance, you must be “workers”. To determine whether you are a worker or not, your employment condition will be assessed comprehensively. The followings are some examples of the criteria to be an eligible applicant.

You must be working under the instructions from an employer
You receive wage or salary, not officers’ remuneration
Your employer keeps and administrate your working hours

To determine the injured is a “worker” or not, his or her employment status such as full time, contracted or casual is not taken into account. Also, a director of company may be considered as a worker if the person receives wage or salary as remuneration and works under the instructions from a chief officer. Also, a family member in the same house may be a worker if such person work for a family business run by his own family under the same employment conditions as non-family workers. Family members or sole proprietors who do not fall into the workers category may be covered by Workers’ accident compensation insurance by submitting a special application.

What Workers’ accident compensation insurance covers?

Unlike public health insurance, Workers’ accident compensation insurance covers only work-related injuries and illnesses. Also, benefits will be paid only after the case is assessed and approved as an occupational accident at the Labour Standards Inspection Office. Generally, Workers’ accident compensation insurance covers the following cases.

Injuries and disabilities occurred in the course of work

This includes injuries occurred during work hours, for example, falling over, falling from a scaffold and operation mistake of the machine. However, if such an accident was deliberately caused or occurred during the worker was engaged in an activity irrelevant to his work, the case will not be approves as an occupational accident.

Physical and mental illness due to work-related duties

For example, an internal disease or death caused by overworking or a mental illnesses such as depression caused by poor working conditions is normally recognized as work-related accident. Also, diseases caused by contacting with hazardous substance or contaminant source are covered by Workers’ accident compensation insurance.

Injury while commuting

Work related injury includes injuries occurred during commuting. However, if such an accident happened while the worker takes a detour to call in somewhere irrelevant to his work.

※Generally speaking, Workers’ accident compensation insurance is a no-fault insurance. Therefore、even an accident caused by worker’s mistake can be covered. But note that accidents occurred due to serious tort by a worker such as an operation under the influence of toxic substance, or deliberately caused accident will not be compensated.

※To receive benefits from Workers’ accident compensation insurance, you must be receive medical treatments at a designated medical institution. If you couldn’t to do so, you have to pay full medical costs first, then apply for a reimbursement. Also, it is important to advise your doctor that your injury or illness is work-related.

Benefits

The followings are examples of benefits from Workers’ accident compensation insurance.

Medical Compensation Benefit: This is designed to cover full amount of medical costs such as doctor’s fee and medicine (only if approved that such costs are necessary).
Wage replacement benefit: 80% of the wage excluding bonus wages and allowances will be paid while the patient is taking a leave of absence.
Illness or Injury Compensation Pension: If a worker cannot recover from injury or illness within 18months and he or she still remains in a serious condition, this benefit will be paid instead of Medical Compensation Benefit.
Nursing Care Compensation Benefit: This benefit is paid to a worker who requires nursing care as a result of serious injury or illness. To be eligible for this benefit, a worker must meet strict criteria regarding serious ness of injury, illness or disability.
Disability Pension Benefit: Regular benefits or one-off allowance will be paid if a worker remains impaired after an accident. The number of payment and the amount will be determined depending on seriousness of the disability.

※In addition to these benefits above, there are compensations in case of a death of worker: Bereaved Family Compensation Benefit which is paid to deceased’s family who were financially supported by the deceased, Funeral Expenses Benefit to compensate costs of funeral and Educational Expenses Benefit to support bereaved who has difficulties to pay children’s educational expenses.

Is your injury work-related?

Workers’ accident compensation insurance is designed to compensate work-related injuries and illnesses. The largest difference from other health insurance is that it covers full amount of medical costs. Also remember that a worker him/herself can make a claim with this insurance even though it is provided by an employer. Some employer do offer to make a claim on behalf of their employees when a work-related accident happens, however, you can make a claim yourself if your employer does not mention it.

Covering work related injuries and illness: Workers’ accident compensation insurance