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HOME > When you become sick or injured? > When sickness or injury keeps you from work
When sickness or injury keeps you from work Benefits in cash
 

If an insured person takes time off work due to a sickness or injury stemming from non-work related activities and is unable to receive salaries, etc., an amount equivalent to two-thirds of the average standard monthly remuneration over the most recent 12-month period (*)÷ 30 is paid each day to maintain the livelihood of the insured person and their family. This is called an "Injury and Sickness Allowance."

Worker's accident compensation insurance covers sicknesses and injuries caused by accidents or disasters occurring on duty or during the commute to and from work. However, 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).

* For individuals who have been insured persons for less than 12 months, the lesser of i. or ii. below:

  1. Individual’s average standard monthly remuneration over the most recent continuous months prior to the month payment of the allowance begins
  2. Society’s average standard monthly remuneration for all insured persons as of September 30 of the preceding fiscal year


Procedure  
 

Fill in the necessary details in the form below, attach a certificate from your employer containing details of the time taken off work and whether any compensations were paid, and an opinion from a doctor stating that you are unable to work, and submit it to the Health Insurance Society.

Procedural
Documents:

1.

"Claim for Injury and Sickness Allowance/ Additional Sum"



Conditions for provision of benefits

Insured persons can receive the Injury and Sickness Allowance in the event all of the following four conditions apply.

1. Treatment for sickness and injury is in progress

Insured persons can be regarded as being under treatment even when they stay at home due to the sickness or injury in question.

2. Treatment prevents insured persons from working

In other words, insured persons cannot continue their previous work due to sickness or injury.

3. Sickness or injury causes insured persons to miss work for three or more consecutive days

Insured persons begin receiving the Injury and Sickness Allowance on the fourth day of consecutive absence. The benefit is not provided during first three days (referred to as the "waiting period").

4. Sickness or injury results in salary loss

The insured person can also receive the balance in the event his or her salary falls below the amount of the Injury and Sickness Allowance.



Benefit provision period


The Injury and Sickness Allowance is available for a period of 18 calendar months. The provision of benefits terminates at a date 18 months after the starting date even if recipients are able to return to work for a time during this period.



Cases in which you are eligible to receive the Maternity Allowance and Injury and Sickness Allowance concurrently


If you are eligible to receive Maternity Allowance and Injury and Sickness Allowance concurrently, payment of the Maternity Allowance will be granted priority. However, if the Maternity Allowance paid is less than the Injury and Sickness Allowance, the difference between the two amounts will be paid.



Cases in which you are eligible to receive Disability Employees' Pension


Health Insurance Societies will stop providing insured persons with the Injury and Sickness Allowance when these people become entitled to the Disability Employees' Pension prescribed under the Employees' Pension Insurance Law or to the Disability Basic Pension prescribed under the National Pension Law. The provision of benefits in these cases will cease even if the period for provision has not ended.
The Injury and Sickness Allowance is not available to a benefit recipient after disqualification receiving the Old Age Employees' Pension.
These rules do not apply when pension income totals less than the Injury and Sickness Allowance. Health Insurance Societies will supply the balance in such cases.


Information for those receiving Injury and Sickness Allowance or undergoing treatment for illness or injury


POINT

If you have a disability pension grade, you are eligible to receive a disability pension after 18 months have passed since the date of the first examination.

If you have a disability pension grade, you are eligible to claim a disability pension at any time until you reach the age of 65 years after 18 months have passed since the date of the first examination.


Many people receiving the Injury and Sickness Allowance or undergoing treatment for an illness or injury file claims for a disability pension late because they do not understand the structure of the disability pension system or how to file a claim for any subsequent exacerbation of a disability (claim filed by a person who did not have a disability pension grade at the date of certification of the disability but does qualify later due to worsening condition).

Be sure to file claims promptly. Filing late may reduce the total pension amount you are eligible to receive.


Information on disability pensions


Contact your local pension office or pension consultation center if you have any questions.
[Addresses of pension offices and pension consultation centers]
https://www.nenkin.go.jp/section/soudan/index.html



Q&A
 
 
Q

Although my injury has healed, I was left handicapped and unable to work. Can I receive an Injury and Sickness Allowance?

 
A

You may be unable to work, but you no longer require treatment.
Therefore, you cannot receive an Injury and Sickness Allowance.
You can receive either the Disability Basic Pension (covered by the National Pension) alone or with the Disability Employees' Pension (covered by the Employees' Pension), or a Disability Allowance (Lump-sum Grant) (under the Employees' Pension) alone, in the event their stabilized conditions correspond to the disability grade table stipulated in the National Pensions Law and the Employees' Pension Insurance Law.

 
 

 
 
Q

I was away from work because of sickness. My doctor then told me I can now return to light work. Does the Injury and Sickness Allowance end when I return to work?

 
A

The inability to perform jobs that used to be possible is a condition for receiving the Injury and Sickness Allowance. This condition still applies even if your doctor says you can perform light work.
However, you will lose the Injury and Sickness Allowance when you start receiving a salary for any light work you do perform. Income is the essential factor in this respect.

 
 


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