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

Be sure to notify the Health Insurance Organization

You can still receive medical treatment under your health insurance after suffering sickness or injury from an accident (traffic or otherwise) due to a Third-party act. However, the treatment paid for by your health insurance should essentially be covered by the individual at fault, and therefore the Health Insurance Organization will only provide temporary payment and will request re-payment at a later date from the individual at fault or his/her automobile insurance company for an amount equivalent to your medical care costs.

For this reason, if you use health insurance when receiving treatment, you must submit a "Notification of Injury or Sickness Due to a Third-party Act" to the Health Insurance Organization as soon as possible.

This also applies to accidents other than traffic accidents due to Third-party acts, such as being bitten by another person’s dog or being hit by a falling object from a nearby building site.

The Health Insurance Organization may contact insured persons to confirm facts relating to Third-party acts based on hospital medical fee bills. We appreciate your cooperation with our inquiries.

*1　Please note the following :

• If you are injured in a traffic accident or by a Third-party act, please call to consult the Health Insurance Organization before submitting your health insurance card to the hospital.
• Make sure you contact us when changing hospitals or completing treatment.
• Health Insurance Request for Issuance of Maximum Co-payment Certificate cannot be used.

*2　Please note that in the following cases health insurance cannot be applied.

• × When at work or on the way to or from the work place (including part-time and temporary work)
• × When false declarations are made
• × When driving under the influence of alcohol

Approach any out-of-court settlements with caution !

Please discuss the matter with the Health Insurance Organization before settling out of court in the event you received medical treatment covered by health insurance. Please avoid settling the matter with the assailant out of court without first consulting the Health Insurance Organization.

In the event that you have already received an out of court damages settlement, heath insurance will not be provided for expenses up to the amount of the settlement. Whether or not an insured person can receive health insurance following an out of court settlement is determined by the contents of the settlement. In the case that a settlement amount including medical treatment expenses is received, or any other gift is received which can clearly be interpreted as including treatment expenses, health insurance cannot be used for ongoing expenses related to that injury.

When receiving medical treatment covered by health insurance for injuries from traffic accidents

1.Victim (insured person / dependent) → individual at fault (accident insurance company)	Claim for damages other than medical treatment expenses, and have the right to claim for compensation for medical treatment expenses
2.Victim (insured person / dependent) → FR Health Insurance Organization	Notification of Third-party Act (right to claim for compensation is transferred to the Health Insurance Organization)
3.Victim (insured person / dependent) → hospital	Medical treatment using health insurance card
4.FR Health Insurance Organization → hospital	Medical treatment expenses payment
5.FR Health Insurance Organization → individual at fault (accident insurance company)	Medical treatment expenses claim (acquisition of subrogation rights to claim for compensation)

If you have been in a traffic accident

STEP 1	Remain calm In cases of shock, you may lose the ability to make calm judgments. React as calmly as possible.
STEP 2	Check the identity of the party responsible Make a copy of address / name, phone number, vehicle registration certificate and accident insurance card of assailant. Compulsory Automobile Liability Insurance
STEP 3	Notify the police Be sure to notify the police, no matter how small the accident. *Get a Traffic Accident Certificate → Issued by the Safe Driving Center
STEP 4	Notify the Health Insurance Organization In the event that you use your health insurance card at a medical facility, make sure you contact and notify the Health Insurance Organization.
STEP 5	Be cautious about reaching a settlement You must exercise caution in the event you settle damages for injuries sustained in an automobile accident out of court, as after-effects may develop. You must inform your Health Insurance Organization prior to an out-of-court settlement in the event you want to receive medical treatment covered by health insurance.
STEP 6	Outsourcing of third party act negotiations FR Health Insurance Organization are outsourcing the business operations of the third party act to Taisho Audit Inc. which is outside specialist business operator. There is a case that the inquiry and confirmation by documents or telephone call from Taisho Audit Inc. If you have the inquiry as above, we ask for your cooperation.

Compulsory Automobile Liability Insurance

In the event that a vehicle injures another person, the law (Automobile Liability Security Act) states that, the owner of that vehicle is responsible for compensation, and can avoid that liability in extraordinary circumstances such as the owner committing suicide. In order to secure payment of compensation, all vehicle owners are obliged to purchase Compulsory Automobile Liability Insurance (CALI).

CALI payout limits

Payout limits for CALI are as follows, but in the event that actual damages exceed the payout limits, the individual at fault must bear the excess cost.

For death (per person)	Damages for death	30 million yen
	Damages up to death	1.2 million yen
For injuries (per person)	Damages for injuries	1.2 million yen
	Damages for permanent disabilities	750k - 40 million yen (depending on grade of disability)

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

If the cause is a workplace accident

If you become sick or are injured due to the actions of another party in the workplace or while commuting, Worker's Accident Compensation Insurance applies instead of health insurance. Check at your company (in charge of social insurance) 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).