If you take time off from work due to sickness
“Injury and Sickness Allowance” is paid when an insured person unable to earn a salary or other income while unable to work due to a nonoccupational sickness or injury.
Injury and Sickness Allowance
■Amounts paid
The Injury and Sickness Allowance is paid when an insured person is unable to earn a salary or other income due to a nonoccupational illness or injury to protect the livelihood of the insured person and his or her family. It is paid in the amount equivalent to the average standard monthly remuneration over the most recent 12 months ÷ 30 × 2/3, per day off work. Even for those receiving a salary or other income from the employer, if this amount is less than the amount of Injury and Sickness Allowance, the difference will be paid as Injury and Sickness Allowance.
- * Method for calculating standard daily remuneration when the period preceding the payment start date is less than 12 months
- Average standard monthly remuneration for the continuous months before the month in which payment began
- Average amount of standard monthly remuneration for all insured persons in the same month as of September 30 of the fiscal year preceding the applicable fiscal year
■Payment period
- Injury and Sickness Allowance of which payment begins on or before July 1, 2020
For a continued period of up to 18 months after the date payment of Injury and Sickness Allowance (statutory benefits) begins- * No payment will be provided past 18 months after the date payment begins. This applies even if the Injury and Sickness Allowance is not paid for part of the payment period due to days worked or for other reasons.
- Injury and Sickness Allowance of which payment begins on or after July 2, 2020
For a total of up to 18 months counting from the date payment of Injury and Sickness Allowance (statutory benefits) begins- * In certain cases, payment will be provided past 18 months after the date payment begins, such as if the Injury and Sickness Allowance is not paid for part of the payment period due to days worked or for other reasons.
Conditions for claiming the allowance
Review
- The Health Insurance Society will review the claim after the documents are submitted.
- Additional documents may be requested, depending on the details of the review.
- In some cases, based on the results of review, the allowance may not be paid.
You may claim the allowance if you meet all of the following conditions:
- You are undergoing treatment for an illness or injury as instructed by a doctor.
- You are unable to perform your previous work duties due to treatment for the illness or injury.
- You have taken at least three consecutive days off from work.
- * If you continue to take time off work beyond the third day, payment of the allowance will begin on the fourth day.
- * The allowance is not paid for the first three days, which constitute a waiting period.
- You are not currently earning a salary.
- * Even if you are receiving a salary, if the amount is less than the Injury and Sickness Allowance, the difference will be paid.
- * The Health Insurance Society will review the claim after the documents are submitted. Additional documents may be requested depending on the state of the review.
Cases in which you are eligible to receive the Injury and Sickness Allowance and Maternity Allowance concurrently
If you become eligible to receive the Injury and Sickness Allowance and Maternity 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.
If you become eligible for Disability Employees' Pension
If you become eligible to receive Disability Employees’ Pension under Employees’ Pension Insurance, payment of the Injury and Sickness Allowance will end. However, the Society will pay the difference if the amount paid by the pension or other program in any of the above cases is less than the amount of the Injury and Sickness Allowance.
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.
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
If the cause is a workplace accident
If the cause is an accident at the workplace or while commuting, Worker's Accident Compensation Insurance applies instead of health insurance. Check with the person responsible at your establishment for more information.
- *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).
You can receive benefits even after leaving your employer
Those who were continually insured as an insured person for ate least one year through the day before the date of loss of eligibility (the date of leaving employment); including periods of coverage by health insurers other than the Recruit Health Insurance Society, but excluding periods of coverage as Voluntarily and Continuously Insured Persons, membership in National Health Insurance, or membership in mutual aid associations; and also satisfy the following payment conditions may continue to claim Injury and Sickness Allowance for the remaining period, even after leaving employment.
| Payment conditions | Must have been receiving or satisfy the conditions for receiving Injury and Sickness Allowance at the time of loss of eligibility. (If you work on the day on which you leave employment, you do not satisfy the conditions for continued receipt of benefits and will not be paid Injury and Sickness Allowance after loss of eligibility (the day after the date of leaving employment). Example: Left employment on March 31, 2017.
|
|---|
- * Those who were continually insured as an insured person for ate least one year through the day before leaving employment by aggregating periods of coverage by health insurers other than the Recruit Health Insurance Society, you will be asked to submit documentation issued by the previous insurers when you claim the Injury and Sickness Allowance for the first time after loss of eligibility.