Workers’ Accident Compensation Insurance: Lost Wage Benefit

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Getting injured due to an accident occurred while working or commuting, becoming ill because of poor working conditions are generally called “workplace injury or illness”. If such an injury or illness is mild one, it probably wouldn’t take so long before you can recover and return to work. However if your injury or illness is a serious one, you may have to be away from work for a long period of time to have medical treatments. In such a case, lost income would be a quite serious concern. As a relief from this problem, you may be eligible to claim Lost Wage Benefit of Worker’s Accident Compensation Insurance, which plays two roles: medical insurance system covering medical costs, and pension system covering lost wages and nursery costs.

Who is eligible?

To be eligible to receive Lost Wage Benefit from Workers’ Accident Compensation Insurance, you must be granted as a “worker”. Claims should be made by the following people or an entity.

Insured worker himself or herself
Family member of insured worker
Employer

About Lost Wage Benefit of Worker’s Accident Compensation Insurance

Eligibility Criteria

Lost Wage Benefit covers lost income of the worker while he or she is absent from work due to a work related injury or illness. To be eligible to receive this benefit, you must meet the following conditions.

You are undergoing medical treatments for injury or illness caused by an accident that occurred while working or commuting.
You are unable to attend work because of the ongoing medical treatments.
You are not receiving wages from your employee because you are unable to work.

Lost Wage Benefit is paid from fourth day of missed work onward. There is a waiting period of three days and no benefit will be paid for this period. If an accident that caused your injury or illness occurred while working, your employer is responsible to compensate lost wages during a waiting period. However, the employer does not bear the responsibility to pay wages during a waiting period if the accident occurred while commuting.
Lost Wage benefit is paid during the entire period that a worker is considered to require medical treatments without a fixed payout period.

What you receive

80% of the average daily wage, that is calculated based on the last 3months wages before a worker is absent from work, is paid as a daily Lost Wage Benefit. To get the average daily wage, monthly allowances such as housing allowance and executive allowance are included in the calculation, however, occasional payments paid with more than 3 months interval such as a bonus and extra allowance are excluded. Also, Lost Wage Benefit is in fact consists of two different payments as follows.

Temporary Absence from Work (Compensation) Benefits: 20% of the average daily wage
Temporary Absence from Work Special Allowances: 20% of the average daily wage

Calculating the average daily wage

For example, if a worker whose monthly wage is 300,000yen works for a company of which monthly wages and salaries are calculated on the last day of month; the total amount of wage of the last 3 months (July to September) is 900,000yen, the total number of days is 92 (July is 31days, August is 31days and September is 30days). Based on these numbers, the average daily wage of this worker will be:

900,000yen / 92days = 9,782yen

Required documents

A claim for Lost Wage Benefit can be made by submitting a claims form accompanied by several supporting documents: a proof of worker’s wage and proof of worker’s absence from work that were issued by the employer and doctor’s medical certificate. The claim form can be obtained from a branch office of Labour Standards Inspection Office as well as from the website of Ministry of Health, Labour and Welfare.

Accident while working: Medical Treatment Benefits Claims Form No.8
Accident while commuting: Medical Treatment Benefits Claims Form No.16-6

*At the first submission of a claim, the attendance record and payroll book from an employer should be attached.
*If an accident was caused by a third party, inquire a Labor Standards Supervision Office about required documents.

Procedures to make a claim

Notify your employer of your intention to take long term absence from work due to work-related injury or illness.
Fill in the Medical Treatment Benefits Claims Form.
Obtain doctor’s certification on the Medical Treatment Benefits Claims Form.
Obtain employer’s certification on the Medical Treatment Benefits Claims Form in regard to wages and your absence from work.
Submit all the required documents at the Labor Standards Supervision Office.
Lost Wage Benefit will be paid into your nominated bank account once your claim is granted.

Reminders

Benefits of Workers’ Accident Compensation Insurance will not be paid unless the Labor Standards Supervision Office approves each claim.
There is a deadline to make a claim with Workers’ Accident Compensation Insurance. To receive Lost Wage Benefit, you must file your claim within 2 years starting on the next day of each unpaid day.
A claim for Lost Wage Benefit should be submitted at the Labor Standards Supervision Office which exercise jurisdiction over the address of an applicant’s workplace.
If a doctor’s certification is made on the claims form, no other certificate from the doctor is required. Also, a medical institution does not have to be designated by Workers’ Accident Compensation Insurance.
If a worker is absent from work for a long period of time exceeding one month, a claim for Lost Wage benefit can be made for the entire unpaid period after the worker returns to work as long as it is submitted within the defined deadline. However, in most cases, claims are made on a monthly basis.

Is your injury work-related?

Lost Wage Benefit covers a part of your income while you cannot work because of work-related injury or illness. Undergoing a long-term treatment may make you concerned about your living costs. At such time, it is reassuring if you can receive insurance benefits even though it does not cover full amount of your usual income. Employee’s Health Insurance provides similar benefits, however, Workers’ Accident Compensation Insurance does not set a fixed payment period and this makes a significant difference. If the worker is unable to make a claim due to a serious condition, a family member or employer can also make a claim on behalf of him or herself. If you end up taking long term unpaid leave because of work-related injury or illness, make a claim for Lost Wage Benefit as soon as possible.