Work Leave Due to Illness or Injury
(Application for Illness or Injury Allowance)
Insured persons who do not receive compensation for a period of time due to work leave caused by a non-occupational illness or injury may receive benefits calculated through the calculation method below for each day of leave. However, workers’ compensation insurance applies to any illness or injury caused by an accident or incident which happened at or on the way to or from work.
Requirements for Receiving Payment
| Necessary for recuperation | The individual may recuperate even at home if healing from a non-work-related illness or injury. |
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| Incapacity to work | The individual has been deemed to have an incapacity to work when unable to do the work in their previous capacity even if able to take on a job with a lighter load. However, a physician’s certificate is required throughout the extent of leave. |
| Three or more continuous days of leave from work | Health insurance does not cover the first three days of leave as a waiting period. Benefits start from the fourth day an insured person is unable to work. |
| No work compensation | Work leave benefits for illness and injury are not paid if the amount of compensation provided by the employer is higher than the illness and injury allowance. If the amount of compensation is less, the EY Japan Health Insurance Society pays the difference. |
Payment period
The illness and injury allowance is provided for up to 18 months from the first payment, counting the total number of days paid. The illness and injury allowance also ends if an insured person receives a disability pension or allowance for the same illness or injury from employees’ pension insurance or an old-age welfare annuity. However, the EY Japan Health Insurance Society pays any difference for the 18-month payment period, counting the total number of days paid, if that amount is less than the illness and injury allowance.
Daily benefit = Standard daily remuneration x 2/3
Calculation Method for Standard Daily Remuneration
| Individual enrolled at least one year as an insured person since the start of premium payments | Average remuneration in the last 12 months |
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| Individual enrolled for less than one year as an insured person since the start of premium payments |
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Fill in the required information in the documents below, obtain a certificate from your physician, and submit these materials to the EY Japan Health Insurance Society.
(Refer to the “Miscellaneous Application Forms” page for information on where to submit application forms.)
- Claim for Injury and Sickness Allowance
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