Workers' Accident 80% or Sickness Allowance Two Thirds

The short answer: a comparison table (on a monthly salary of 300,000 yen)

Sources: Ishikawa Labour Bureau, "Leave (compensation) benefits" [Ishikawa Labour Bureau]; Japan Health Insurance Association, "Injury and sickness allowance" [Japan Health Insurance Association]

The basic daily benefit amount under workers' accident insurance is the total wage for the preceding three months divided by the number of calendar days in that period, so on a monthly salary of 300,000 yen it is 900,000 yen divided by 92 days, or about 9,783 yen. The standard daily remuneration for the injury and sickness allowance is the standard monthly remuneration divided by 30, or 10,000 yen. The daily base is slightly higher for the injury and sickness allowance, yet the gap in the rates (80% against two thirds) puts workers' accident insurance ahead.

Which one applies is decided by why you are off, and you cannot choose

The injury and sickness allowance is payable for an illness or injury outside work, so it is not paid for an injury or illness that counts as a work accident. Conversely, workers' accident insurance is not granted unless work or commuting caused the condition. In other words, which benefit you receive is not something you or your company picks: it follows from the cause.

Some companies ask you to put an injury sustained at work through health insurance instead, on the grounds that "using workers' accident insurance raises the company's premiums" or "it draws the attention of the inspection office". That is concealment of an industrial accident and a criminal offence under the Industrial Safety and Health Act. You can file the claim yourself directly with the Labour Standards Inspection Office, and it will be accepted even if the company does not fill in its certification section. If you have already been treated under health insurance, you can switch to workers' accident insurance afterwards.

You cannot have both: workers' accident insurance comes first, and only the difference is paid as the injury and sickness allowance

You cannot receive both the leave compensation under workers' accident insurance and the injury and sickness allowance for the same condition. A Ministry of Health, Labour and Welfare notice states that only where the leave compensation is lower than the injury and sickness allowance is the difference paid as the injury and sickness allowance[MHLW, 1958 notice]. In the usual case, where workers' accident insurance pays more, no injury and sickness allowance is paid.

If you claim under workers' accident insurance and the claim is refused, you can go back and claim the injury and sickness allowance. The time limit for the injury and sickness allowance is two years for each day you were off, however, so when the workers' accident investigation drags on it matters either to take the injury and sickness allowance first on the understanding that you will repay it depending on the outcome, or to check with your health insurer how it handles the time limit.

How long the money lasts: the paths split at a year and six months

• The injury and sickness allowance ends after a cumulative year and six months from the first payment. If you return to work and then take leave again, the days already paid are added together, and once they reach a year and six months the payments stop (the switch to a cumulative count came in 2022). If you still cannot work after that, consider claiming the disability pension.
• Workers' accident insurance continues until you recover. There is no deadline. If a year and six months after treatment began you have not recovered and your condition is serious enough to fall within grades 1 to 3, it switches to the injury and disease (compensation) pension (313, 277 or 245 days of the basic daily benefit amount), which is more generous than the leave compensation. If you do not reach grade 3, the leave compensation continues.
• What you pay for treatment also differs. Under workers' accident insurance the medical (compensation) benefit covers the treatment in full and you pay nothing at the counter (benefits in kind at a designated hospital). With the injury and sickness allowance you pay the usual 30%, with the monthly ceiling set by the high-cost medical expense benefit.

The paperwork, and what keeps being deducted while you are off

1. Workers' accident insurance: Form No. 8 (Form No. 16-6 for a commuting accident) to the Labour Standards Inspection Office. You file it with a doctor's certification and the company's certification of your wages and days off. If the company will not cooperate, you can state that and file it yourself. Claims are usually made a month at a time, and the first payment takes one to two months.
2. Injury and sickness allowance: to the Japan Health Insurance Association or your health insurance society. The application form goes in with your doctor's opinion and the company's certification. This too is usually filed a month at a time, and the first payment arrives two to three weeks after the application. For the conditions in detail, see the article on the injury and sickness allowance.
3. Neither exempts you from social insurance premiums. Health insurance and employees' pension premiums keep accruing while you are off, and since they cannot be deducted from pay, either the company advances them and settles up later or you transfer them yourself. On a monthly salary of 300,000 yen your own share is around 45,000 yen a month. Resident tax also continues, based on last year's income.
4. Pay from the company is offset against the benefit. Workers' accident insurance covers days on which you receive no wage, so nothing is paid for a day on which you received 60% or more of the average wage. The injury and sickness allowance is likewise reduced by the pay you received. Days of paid annual leave fall outside both.

What happens if you leave the company

Leave compensation under workers' accident insurance continues after you leave. It cannot be cut off because you quit, and it runs until you recover. The injury and sickness allowance requires the conditions for continued benefits, namely that you were insured continuously for at least a year up to your last day and that on that day you were receiving the allowance or were in a position to receive it. Meet them and you can draw the remaining period after leaving. If you come in on your final day to say your goodbyes, you may be treated as fit to work and lose the continued benefit, so take that day off.

Once you are fit to work again after leaving, you switch to unemployment benefit (the basic allowance). Someone who quit because of illness can receive it as a person who left for a specific reason, with no waiting restriction, and the benefit period can be extended for the time you are unable to work. For the procedure, see how to receive unemployment insurance.

Note that freelancers and one-person contractors have no injury and sickness allowance, and nothing is paid under workers' accident insurance either unless they have taken out special enrolment. See workers' accident premiums for one-person contractors.

Frequently asked questions

Summary

• For injuries at work or during commuting, workers' comp pays roughly 80% of wages; for off-the-job injuries, health insurance sickness benefit pays two-thirds.
• Which one applies depends on the reason for the leave, and you cannot choose. You cannot receive both, and workers' comp takes priority.
• On a ¥300,000 monthly salary, 30 days off pays about ¥235,000 under workers' comp versus about ¥200,000 under the sickness benefit.
• The sickness benefit ends after a cumulative 1 year and 6 months. Workers' comp continues until recovery and is not cut off even after you leave the company.
• Having health insurance cover an on-the-job injury is an illegal cover-up of a workplace accident. You can file a workers' comp claim directly with the Labour Standards Inspection Office yourself.

Reference links (sources)

This article is based on the materials below. The amounts are estimates and vary with the make-up of your wages, with bonuses, and with the health insurer you belong to.

• Ishikawa Labour Bureau, Leave (compensation) benefits (60% plus 20%, the three-day waiting period, the 200 yen co-payment, the move to the injury and disease pension, the forms)
• MHLW, Workers' accident compensation (an outline of the system and the claim procedure)
• Japan Health Insurance Association, Injury and sickness allowance (two thirds, a cumulative year and six months, continued benefits after leaving)
• MHLW, On receiving both workers' accident leave compensation and the health insurance injury and sickness allowance (Notice Hoken-hatsu No. 95-2 of 8 July 1958)

Note: this article is general information. For the details of certification and benefits under workers' accident insurance, check with the Labour Standards Inspection Office, and for the injury and sickness allowance with the health insurer you belong to.