About injury and sickness allowance
When you take day off from work due to illness
＜Injury and sickness allowance＞ will be provided.
If you take day off from work due to nonoccupational sickness or injury, and the company does not provide you with a salary, you will be provided with an injury and illness allowance to support the lives of the insured and your family.
In addition, there is a review of the payment decision, and depending on the history of consultation at the hospital, medication history, symptoms, etc. and the status of receiving the past injury and illness allowance, if necessary, to the insured / doctor and the previous health insurance association, etc. We will make inquiries and properly judge whether or not payment is possible.
Conditions for receiving allowance
This benefit is paid when all four of the following conditions are met. ① to ④
- ① When receiving medical treatment due to illness or injury caused by non-work
- I am being treated for illness or injury under the direction of a doctor.
- recuperation at home is acceptable
- ② The doctor proves that he / she cannot get a job because of medical treatment.
- You are unable to perform your previous job because you are recuperating from sickness or injury.
- ③ You must be absent for at least 4 consecutive days off.
- Payment of this benefit begins on the fourth consecutive day off.
The first three days are referred to as the waiting period, and no benefits are paid for those days.
The waiting period may be paid holiday or public holiday.
- Payment of this benefit begins on the fourth consecutive day off.
- ④ When you cannot get a salary during the rest period
- However, even if you receive a salary, if it is less than the injury and illness allowance, the difference will be paid.
Payment amount
For each day you take a day off from work, you will be paid an amount equivalent to two-thirds of the standard daily salary.
360,000 yen ÷ 30 days = 12,000 yen ← Standard daily remuneration
12,000 yen x 2/3 x 27 days (excluding the first 3 days) = 216,000 yen will be paid
Payment period
The payment period is from the date of payment for the same illness * to 1 year and 6 months.
This means that it is 1 year and 6 months on the calendar, so even if you go to work on the way, you will not be paid for a period exceeding 1 year and 6 months from the date of the start of payment.
※"With the same illness" does not necessarily mean "the same illness name", but refers to illnesses with the same cause or symptom, or related illnesses or injuries.
Statute of limitations
The right to claim benefits is two years. (The right expires after the deadline.)
You can claim each day you were unable to work within two years from the next day.
Procedure
Injury and illness allowance bill
- Fill in the insured person entry field and seal
- Ask the doctor to fill in and seal the doctor's opinion column
（Detailed description of not able to work） - Ask the company to prove attendance, salary payment status, etc. in the business owner column.
（The company attaches a copy of the attendance record during the billing period and a copy of the salary statement with the absenteeism deduction formula） - Submit to the Health Insurance Association via the health insurance office worker at your place of employment
- When applying for injury, please also submit the injury cause report.
However, if it is due to the actions of a third party, please contact the union first.
- Please submit after the closing date of payroll calculation.
- Please apply in units of one month according to the closing date of salary as much as possible.
- Please make sure that the application period and the period when the doctor in charge recognizes that you cannot work are the same.
- As a general rule, please fill in the opinion column of the doctor in charge for the period before the certification date.
- After submitting the application form, it may take some time to make a decision due to examination, etc.
In this case, we will notify the health insurance office staff at your place of employment. - Please note that you may be asked to submit other documents for examination.
About Injury and Sickness Allowance after leaving your employer
If the insured period of health insurance continues for one year or more until the retirement date (the day before the disqualification date), and the injury and illness allowance is paid at the time of retirement or the conditions for receiving the payment are met (*) Will be paid the same injury and illness allowance as when he/she was insured.
However, you will not be able to receive unemployment benefits from employment insurance during the period when the injury and illness allowance is paid.
（※）Specifically, it is the case of "If you are absent from work for 3 consecutive days or more due to unable to work before the retirement date" and " If you are take day off from work due to unable to work on the day of retirement".
Please refer to Q1 of [Injury and sickness allowance Q&A]
Procedure of after leaving your employer.
「Injury and illness allowance bill」・「Recuperation status / Daily life status petition」
- Fill in the insured person's entry field and seal
- Ask the doctor to fill in and seal the doctor's opinion column
- It is not necessary to fill in the business owner column, instead fill in the "statement of medical treatment / daily life situation" and attach it with a seal
- After the procedure for extending the employment insurance benefits at Hello Work, attach a copy of the notice of extension of the benefits period.
Injury and sickness allowance Q&A
