Traffic Accidents and Health Insurance
Traffic Accidents
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- Traffic Accidents
- Traffic Accidents and Health Insurance
- I want to consult about a traffic accident in Yaizu/Makinohara
- Can I use health insurance for treatment of injuries from a traffic accident?
- I want to know about treatment of traffic accident injuries and health insurance
Are you troubled by issues like these in Yaizu, Makinohara, Omaezaki, Fujieda, Shimada, Yoshida Town, or surrounding areas?
Yaizu Sogo Law Office offers a free initial legal consultation regarding traffic accident concerns. There is no obligation to retain our services after the initial consultation. We are also available on weekday evenings and Saturdays. Please feel free to contact us by phone or email.
Health Insurance Can Be Used for Traffic Accidents
Some hospitals may explain that "health insurance cannot be used for treatment of traffic accidents," but health insurance can be applied to the treatment of traffic accident injuries without any problem. The Ministry of Health, Labour and Welfare has issued the following notice.
Note
○ Handling of Insurance Benefits for Injuries Caused by Criminal Victimization [National Health Insurance Act]
(March 31, 2014)
(/Ho-Ho-Hatsu No. 0331-1 / Ho-Koku-Hatsu No. 0331-2 / Ho-Kou-Hatsu No. 0331-12/)
(Notice from the Director of the Insurance Division, Director of the National Health Insurance Division, and Director of the Elderly Medical Care Division, Insurance Bureau, Ministry of Health, Labour and Welfare, addressed to the President of the Japan Health Insurance Association, Presidents of Health Insurance Societies, Directors of Prefectural National Health Insurance Divisions, and Directors of Prefectural Latter-Stage Elderly Medical Care Divisions)
(Official Seal Omitted)
Injuries arising from criminal victimization are, under the respective medical insurance laws (the Health Insurance Act (Act No. 70 of 1922), the Mariners Insurance Act (Act No. 73 of 1939), the National Health Insurance Act (Act No. 192 of 1958), and the Act on Assurance of Medical Care for Elderly People (Act No. 80 of 1982)), treated as ordinary insured events and are covered by medical insurance benefits.
Furthermore, since a written pledge from the perpetrator acknowledging liability for damages to the insurer is not a necessary condition for providing medical insurance benefits, benefits shall be provided even if the insured person who is a victim of a crime does not submit such a pledge.
This handling was set forth in the joint notice dated August 9, 2011 (Ho-Ho-Hatsu No. 0809-3 / Ho-Koku-Hatsu No. 0809-2 / Ho-Kou-Hatsu No. 0809-3), entitled "Handling of Insurance Benefits for Injuries Caused by Criminal Victimization and Automobile Accidents" (Appendix 1), issued by the Director of the Insurance Division, the Director of the National Health Insurance Division, and the Director of the Elderly Medical Care Division, Insurance Bureau, Ministry of Health, Labour and Welfare.
In light of the summary (Appendix 2) compiled by the "Study Group on Expansion of the Crime Victim Compensation System and Creation of a New Compensation System," which was convened based on the "Second Basic Plan for Crime Victims" (Cabinet Decision of March 25, 2011) and the related decision of the Council for the Promotion of Crime Victims' Policies (March 25, 2011), we hereby reaffirm the above handling. We ask that you respond appropriately in accordance with the intent of this notice, and that Prefectural National Health Insurance Divisions disseminate this information to insurers within their jurisdiction, and Prefectural Latter-Stage Elderly Medical Care Divisions disseminate it to the Wide-Area Unions for Latter-Stage Elderly Medical Care and Municipal Latter-Stage Elderly Medical Care Divisions within their jurisdiction.
End
In summary, the following applies:
- By submitting a "Notification of Injury Caused by a Third Party," you can use health insurance.
- Health insurance can be used even if the at-fault party refuses to pay.
- It is incorrect for a hospital to say "you cannot use it."
Benefits of Using Health Insurance
The benefits of using health insurance for traffic accidents are as follows.
① Out-of-pocket costs are only 30% (non-insured treatment is 100%)
With non-insured (free) treatment, medical costs tend to be high, and insurance companies are more likely to demand termination of treatment.
By using health insurance, medical costs are kept lower, making it easier to secure the necessary treatment period.
② The impact of comparative negligence is reduced
When the victim also bears some fault, comparative negligence applies. When health insurance is used, only the 30% co-payment borne by the victim at the hospital is recognized as damages, and comparative negligence is applied to this co-payment amount.
If health insurance is not used and non-insured treatment is chosen, the full 100% becomes the damages, and comparative negligence is applied to that entire amount.
Generally, when the victim bears a significant degree of fault, insured treatment is less affected by comparative negligence, so using health insurance increases the amount of insurance benefits the victim can receive.
Specifically, in a case where "medical costs are 200,000 yen and the victim is 20% at fault," the following applies:
| Non-insured treatment (100%) | 200,000 yen × 20% = 40,000 yen reduction |
|---|---|
| Health insurance (30% co-pay) | 60,000 yen × 20% = only 12,000 yen reduction |
As shown, using health insurance significantly reduces the victim's burden.
③ Treatment can continue even if the at-fault party's insurance company is reluctant to pay
The opposing insurance company may claim that "the necessity of treatment is low" and demand termination, but by using health insurance, the victim can continue treatment under their own insurance, which is highly advantageous in practice.
④ Initial response after the accident becomes smoother
Immediately after an accident, there is often confusion—the insurance company cannot be reached, the opposing insurance company will not act, fault ratios are disputed, etc.—but by using health insurance, treatment can be started smoothly.
Procedure for Using Health Insurance: "Notification of Injury Caused by a Third Party"
When using health insurance, the following documents are typically submitted:
- Notification of Injury Caused by a Third Party
- Accident Report
- Document stating the other party's information (name, address, insurance company, etc.)
Health insurance can be used even before these documents are submitted. A hospital cannot refuse use on the grounds that the notification has not been filed.
Reasons Hospitals Refuse Use of Health Insurance
The main reasons hospitals say "health insurance cannot be used for traffic accidents" are as follows:
- Non-insured treatment generates higher medical fees for the hospital
- Using health insurance requires procedures that increase the hospital's administrative burden
- It is easier for the hospital to deal directly with the opposing insurance company
However, these are matters of the hospital's convenience, and legally, health insurance can be used for traffic accidents.
In many cases, having an attorney explain the situation to the hospital resolves the issue.
Does the Opposing Insurance Company Dislike the Use of Health Insurance?
The opposing insurance company often requests that "you use health insurance" because non-insured treatment tends to result in higher medical costs.
However, it is important to note that this is not because "it benefits the victim" but because "the insurance company wants to reduce its own burden."
What matters most is making the choice that is "most advantageous for the victim."
Summary
Whether to use health insurance for a traffic accident is
- Medical costs
- Comparative negligence
- Settlement amount
- Whether treatment can continue
- Relationship with the opposing insurance company
a very important decision that significantly affects all of the above.
It is not uncommon for the final amount received to differ by several hundred thousand yen or more depending on whether health insurance is used.
If you are unsure, we strongly recommend consulting an attorney at any stage—whether during treatment or before settlement.
Frequently Asked Questions
The hospital told me "health insurance cannot be used for traffic accidents." Is this true?
This is incorrect. The Ministry of Health, Labour and Welfare has clearly stated in its notices that "health insurance can be used for traffic accidents."
Will my treatment be limited if I use health insurance?
No. You can receive all necessary treatment, just as with regular medical care.
The opposing insurance company told me to "please use health insurance." Should I comply?
Whether to comply depends on the case. In many instances, the insurance company is saying this merely for its own convenience, so please consult with us first.
When should I submit the Notification of Injury Caused by a Third Party?
It can be submitted even after you have received treatment. Health insurance can be used even before submission.
Can workers' compensation insurance also apply?
If a traffic accident occurs during the course of a worker's duties or during commuting, workers' compensation insurance benefits can be received. For accidents during work or commuting, it is possible to combine workers' compensation with traffic accident damages, and in many cases, this results in a higher total amount received.
In particular, the "Special Leave of Absence Benefits" are not deducted from claims against the at-fault party, so using workers' compensation is generally more advantageous.
Can both workers' compensation and health insurance be used?
They cannot be used simultaneously, but since workers' compensation may be more advantageous in some cases, consultation is necessary.
The Initial Legal Consultation for Traffic Accidents at Yaizu Sogo Law Office Is Free of Charge
Yaizu Sogo Law Office provides a free initial legal consultation regarding traffic accidents.
We handle all traffic accident-related legal matters, regardless of severity or whether they involve property damage or personal injury. If you are feeling stressed by dealings with insurance companies, or if you want to know whether the amount offered by your insurance company is fair, please do not hesitate to consult with us.
Yaizu Sogo Law Office is available not only during regular weekday hours but also on weekday evenings and Saturdays. Please contact us by phone or email to schedule a legal consultation.
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If you are facing issues with traffic accidents, debt restructuring, or inheritance:You can consult a lawyer for free
At Yaizu General Law Office, free legal consultations are available for those facing traffic accidents, debt restructuring, or inheritance issues. There is no obligation to retain our services after a free consultation. For other areas of law, consultations are available at 5,500 yen (tax included) per 30 minutes. Please do not hesitate to contact us if you need assistance.
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About Yaizu General Law Office
Yaizu Office
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- Address
- 〒425-0028
3-11-4 Ekikita, Yaizu City,
Shizuoka Prefecture
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- Phone
- 054-639-5573
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- Business Hours
- Mon-Fri 9:00 AM - 7:00 PM Sat 9:00 AM - 5:00 PM / Closed: Sundays & Holidays
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- Access
- 6-minute walk from Yaizu Station / Parking available
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- Service Area
- Yaizu, Makinohara, Fujieda, Shimada, Yoshida, and surrounding areas
Makinohara Office
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- Address
- 〒421-0422
Maison de Hautoku 1F, 140-4 Shizunami,
Makinohara City, Shizuoka Prefecture
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- Phone
- 0548-28-6710
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- Business Hours
- Mon-Fri 9:00 AM - 7:00 PM Sat 9:00 AM - 5:00 PM / Closed: Sundays & Holidays
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- Access
- 4-minute walk from Shizunami 1-chome (Bus Stop) / Parking available
- Access
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- Service Area
- Yaizu, Makinohara, Fujieda, Shimada, Yoshida, and surrounding areas
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Free Legal Consultation Process
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01
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Making a Reservation for Free Legal Consultation
Please make a reservation by phone or email. There is absolutely no obligation to retain our services after a free consultation. If you are in need of help, please feel free to come in for a consultation.
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Free Legal Consultation with an Attorney
An attorney will personally listen to the details of your situation. Bringing a memo or documents summarizing your issue will help the consultation go smoothly. If the matter is resolved through consultation alone, the process ends here.
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If You Wish to Retain an Attorney
During the consultation, we will also explain the fees and outlook should we take on your case. If you wish to proceed, you may retain us at that time. You are also welcome to take the information home and consider it before making a decision.
