If you become sick or are injured due to the actions of another party

You can use health insurance (your health insurance card) to receive treatment for an illness or injury caused by the actions of another party—for example, traffic accidents (including bicycle accidents) or unwarranted violence or assault. However, in such cases you must contact the Recruit Health Insurance Society in advance to obtain approval of using your health insurance card.
After obtaining approval, promptly submit the Notification of Injury or Sickness due to Third-party Act and other required documents.

However, you cannot use health insurance (your health insurance card) for an illness or injury suffered while commuting or on the job. Such cases are covered by Worker’s Accident Compensation Insurance. Contact the staff in charge of Worker’s Accident Compensation Insurance at your employer (the company that pays your salary).

The Recruit Health Insurance Society subcontracts certain procedures to Taisho Audit. The subcontracted procedures involve sending and collecting documents titled Cause of Injury Investigation Form and Notification of Injury or Sickness due to Third-party Act and other required documents, as well as claiming compensation from the parties responsible and casualty insurers.
If you receive postal mail from Taisho Audit, open it immediately and submit the requested documents.

* A Cause of Injury Investigation Form may be sent for broken bones or other traumatic conditions upon billing of insurance medical fees by the medical care institution. In addition, a Notification of Injury or Sickness due to a Third-party Act will be sent for treatment of conditions/injuries judged to be attributable to third-party actions even if the Society was not notified in advance. Please submit the required documents in such cases.

Be sure to notify the Health Insurance Society

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 Society 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 Society and submit the Notification of Injury or Sickness due to a Third-party Act and other necessary documents as soon as possible.

If you have been in a traffic accident

STEP1Remain calm
In cases of shock, you may lose the ability to make calm judgments. React as calmly as possible.
STEP2Check the identity of the party responsible
Check matters such as the license plate no., driver's license, and vehicle inspection certificate.
STEP3Notify the police
Be sure to notify the police, no matter how small the accident.
STEP4Be 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 Society 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

Illness or injury due to third-party action suffered while commuting or on the job

Worker’s Accident Compensation Insurance, not health insurance, provides coverage for an illness or injury due to third-party action suffered while commuting or on the job. Promptly contact the staff in charge of Worker’s Accident Compensation Insurance at your employer (the company that pays your salary).
Note that if you received treatment using health insurance (your health insurance card) in such cases, the Recruit Health Insurance Society will demand a refund of the amount it paid at a later date.

* 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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