There is a traffic accident
(injury or illness caused by the act of a third party)
In principle, medical expenses due to traffic accidents, etc. are basically paid by a third party (perpetrator) from liability insurance or voluntary insurance, but you can receive medical treatment using health insurance. However, if you want to receive medical treatment with health insurance, please contact the health insurance association and promptly submit a "Notification of injury or illness caused by a third party act". Originally, the health insurance union will once collect and pay the medical expenses that the perpetrator should pay, and the health insurance union will charge the perpetrator (the insurance company on the perpetrator side) for the cost.
If you are sick or injured while you work or commute to work, you will receive medical treatment under the accident compensation insurance instead of health insurance.
Points in case of a traffic accident
| Confirm the other party | Check the other party's number, color, name, driver's name, address, work place, liability insurance certificate, vehicle verification, etc. |
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| Contact the police | Immediately notify the police and receive a "vehicle accident certificate". |
| Contact the Health Insurance Society |
Let us know the details of the accident, the date of the accident, the car insurance of the other party, and confirm whether you can use your insurance card.
* Depending on the non-life insurance you have, the non-life insurance company may assist you in creating and submitting a "Notification of Injuries or Diseases Caused by a Third Party Act".
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Be careful about the settlement
It is important to carefully discuss the settlement by considering the aftereffects. If you negotiate carelessly, you may end up crying and falling asleep at an unreasonably low price, or you may not be able to receive medical insurance within the range of the negotiation.
If you wish to make a settlement, please be sure to contact the Health Insurance Society before making a settlement.
An example that requires special attention for the contents to be negotiated
| (Ex1) When a settlement is concluded while receiving medical treatment. | If the victim (insured or dependent) receives compensation including medical treatment costs, he / she will not be able to receive medical treatment after that date. Even if the symptoms are not fixed and the treatment is prolonged, you will have to pay the full amount. |
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| (Ex2) When making a settlement such as "I do not need medical expenses because I am being treated by health insurance" | Since the claim for medical expenses for damages will be abandoned and the health insurance association will not be able to charge the perpetrator for the medical expenses that have been replaced, the victim (insured) will be responsible for all medical expenses. |
If you have an accident while commuting to work or at work (at work)
If you have an accident due to a third party's act such as a traffic accident during work (at work) or on the way to work, contact the company immediately! !
In this case, health insurance cannot be used because the insurance benefits are provided by the workers' compensation insurance.
About "injuries and illnesses caused by the actions of third parties"
The main case of a third-party act is a car accident, but in the following cases it will also be a third-party act, so it is necessary to notify the Health Insurance Society.
Examples of third-party acts
- Quarrel
- Injury case
- Hit away
- Ski or snowboard collision
- Bicycle collision accident
- I was bitten by another dog
How to get the accident certificate
The Traffic Accident Certificate is issued by the Automobile Safety Driving Center. It will not be issued without notification to the police, so be sure to notify the police as a personal injury.
Please note that you may not be able to claim the treatment fee in case of a property damage accident.
| Accident between cars | When both cars are injured in an accident between cars, it is almost always that both have some negligence. In that case, both are both perpetrators and victims at the same time. Therefore, the third party acts mutually. |
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| Self-injury accident | If a passenger is injured due to a self-damage accident such as looking aside, the driver becomes a perpetrator and acts as a third party. |
| Injury | If you are injured by an accident other than a car accident or violence, if you are bitten by an animal owned by another person, or if you have food poisoning due to catering, it will be a third party act. Both require notification to the Health Insurance Society. |