In some cases, an employee who is receiving an injury and disease allowance under the health insurance program leaves the company due to difficulty in returning to work. By satisfying certain conditions, such worker may receive an injury and disease allowance after retiring. This article explains about such cases.
[1] Requirements for receiving an injury and disease allowance
Injury and disease allowance is provided to workers who are absent from work and unable to receive wages due to an injury or illness to compensate for their income. To receive allowances, workers must satisfy all of the four requirements below.
1. The worker is taking leave of absence due to an injury or illness unrelated to work;
2. The worker is currently unable to work;
3. The worker could not work for at least four days, including three consecutive days (waiting period).
4. Wages were not paid during the leave.
[2] Requirement for continued payment
Workers who satisfy the requirements described in [1] may receive an allowance after leaving the company, if they meet the following two conditions.
1. The worker had been insured continuously for at least one year up to the day before the insurance deregistration date (retirement day, etc.)
2. The worker received or was eligible to receive an injury and disease allowance as of the day before the insurance deregistration date (retirement day, etc.)
Concerning 2 above, a worker, confirmed by a physician to be unable to work, will be considered capable of work, if they go to office on the retirement day for job handover, etc. and becomes unable to receive the allowance after retiring.
[3] Treatment of a case a worker has retired without receiving allowance
In some cases, workers take annual paid leave and leave the company subsequently without receiving an injury and disease allowance. A worker who did not receive injury and disease allowance before leaving the company may claim the allowance after retirement, if the requirements explained in [1] are satisfied on the fourth day following a three-day waiting period. If a worker took paid leave up to the retirement day, the worker does not meet the fourth requirement above, “The worker was not paid wages for the absent days,” and therefore the allowance will not be provided. Such worker becomes entitled only after the retirement and wage payment has stopped.
[4] Period of allowance payment
From January 2021, workers may receive injury and disease allowances on a same injury or disease for a total period of one year and six months from the day the payment is started. Workers who received allowances before retirement may continue receiving for the rest of the period.
For workers who leave the company for personal injury or disease, the continued allowance is an important source of income. Companies are expected to check requirements carefully and provide detailed explanation to applicable employees during the retirement procedure.
[Reference]
Japan Health Insurance Association, “Injury and disease allowance”
https://www.kyoukaikenpo.or.jp/g6/cat620/r307/
*The content is based on laws and regulations as of the date of the article.
