Off work due to injury? Injury and sickness allowance of Employee’s Health Insurance

photo by Claus Rebler

Sometimes, you end up getting injured or sick while you are working in Japan. If such an injury or illness was caused by a work-related accident, Workers Injury compensation Insurance will provide coverages for medical expenses and wage replacement. But what happens if such an accident happened while you were not working? Unfortunately, Workers Injury compensation Insurance does not cover non-work-related accidents but you still have to be off work until you get recovered. This would be a nightmare. If you end up having a long leave because of non-work-related injury or illness, make a claim for Injury and Sickness Allowance with Employee’s Health Insurance. You may be able to receive some wage replacement.

About Injury and Sickness Allowance

Injury and Sickness Allowance is one of the benefits paid by Employee’s Health Insurance to ensure the living of workers who are forced to be off work for a long period of time due to non-work-related accidents. You can claim this benefit when your employer does not receive sufficient amount of wages from his or her employer during the off-work period, and receive two-thirds of their original wage will be paid for up to 18months. To be eligible for Injury and Sickness Allowance, you must meet the criteria.
Note that this allowance is only available for members of Employee’s Health Insurance and no such allowance is provided by National Health Insurance. Therefore, people who only have enrolled in National Health Insurance, for example sole-proprietors and their families, are not eligible.

Eligibility criteria

To receive Injury and Sickness Allowance, you must meet the following conditions.

You are off work because of an injury or sickness caused by non-work-related accident: If the cause of your injury or sickness is work-related accident, you may claim benefits with Workers Injury Compensation Insurance.
You are unable to perform your regular job duties: Your eligibility will be determined by assessment according to the evidences such as doctor’s certificate and record of your employment conditions.
You are absent from work at least four days including the first three consecutive days: Payment will begin on the fourth day off following three consecutive days off. The first three consecutive days are waiting period and there is no payment during this period. If you had a few days off but none of them meet the three consecutive days rule, you will not be eligible for this benefit. Waiting period can include any day of week: week days, weekends and public holidays.
You are on unpaid leave: If you are paid but such payments are lower than the amount of Injury and Sickness Allowance, you can claim the difference.

How much do you receive?

Daily amount of Injury and Sickness Allowance is two-thirds of the average daily wage of the past 12months. If you haven’t stayed at the current job for less than 12months, your daily payment will be calculated by using a monthly amount whichever lower of 280000yen or your actual average monthly wage.

How to make a claim

Procedures to make a claim may vary depending on the insurer. This section will use Japan Health Insurance Association, the largest public insurance provider in Japan, as an example.

Required Documents

Application form
Employer’s declaration (Page 3 of application form)
Doctor’s certificate (Page 4 of application form)
Description of the cause of injury: If you have an injury
Notification of an accident by a third party: If the accident was caused by a third party
Certificate of expulsion from family register: If a worker has deceased
Photo ID: If you have wrote your personal identity number on the application form instead of your insurance card number

Application procedures

Notify your employer that you want to take a leave for a certain period of time due to injury or illness
Download the application form or take a copy from a branch office of Japan Health Insurance Association
Fill in first two pages of application form
Once your leave ends, ask your employer to fill in the third page of the application form
Once your leave ends, ask your medical care provider to fill in the fourth page of the application form
Prepare other required documents according to the statement of your injury or illness
Benefit will be paid into your bank account approximately one month from submission if your application is granted

Reminder

Employer’s Declaration and Doctor’s Certificate pages should be completed after the last day of application period otherwise your application will be declined as it is unable to prove that you were absent and unable to work throughout the period.
Cost for Doctor’s Certificate is 1000yen in full, 300yen after Employee’s Health Insurance is applied.
You can make a claim up to two years from the first day of the leave you had. If you had a leave of absence longer than one month, you can make a claim after you return to work. However, most employees make a claim every time a monthly wage calculation period renews.

Fortunately, you have Employee’s Health Insurance

Getting injured or becoming sick is something you occasionally experience while your stay in Japan. But sometimes, it can be a serious one that forces you to be away from work for a few weeks or even months. Unfortunately, only few companies allow their employers paid sick leave for such a long period of time. Injury and Sickness Allowance of Employee’s Health Insurance is designed to support employees who are unable to work because of injury or illness. There is no nationality test in the eligibility criteria of this allowance. Foreign national employees are also entitled to receive this allowance if they meet the conditions.