Flowchart for Sickness and Injury Allowance Application and Required Documents
目次
Sickness and injury allowance helps ease financial worries during a leave of absence. Let's organize the application process and necessary documents.
For consultations regarding a doctor's opinion, please feel free to contact us via LINE first.
Consult on Official LINEWhat is Sickness and Injury Allowance?
This is a benefit received by company employees enrolled in health insurance when they are unable to work due to illness or injury outside of work. The benefit amount is approximately two-thirds of the amount calculated based on the standard monthly remuneration for the most recent 12 months, and the payment period is a maximum of 1 year and 6 months.
Estimated Benefit Amount – Check with specific examples
The amount of sickness and injury allowance is calculated using the following formula:
Average standard monthly remuneration for the 12 months prior to the start of payment ÷ 30 days × 2/3 × number of days paid
| Standard monthly remuneration (average) | Estimated daily allowance | Estimated monthly allowance (30 days) |
|---|---|---|
| 240,000 yen | Approx. 5,300 yen | Approx. 160,000 yen |
| 300,000 yen | Approx. 6,700 yen | Approx. 200,000 yen |
| 360,000 yen | Approx. 8,000 yen | Approx. 240,000 yen |
The standard monthly remuneration differs from the amount stated on your monthly pay slip; it is the amount based on the classification used to calculate social insurance premiums. For the exact amount, please check with your health insurance society or the Japan Health Insurance Association, or inquire with your payroll department.
Eligibility Criteria
- Undergoing medical treatment for an illness or injury not related to work
- Unable to work
- Having taken 4 or more days off work, including a waiting period of 3 consecutive days
- Not receiving salary during the leave, or receiving less than the sickness and injury allowance
Application Process
- Receive a medical examination and have a doctor write an opinion letter stating that you are unable to work.
- Have your company fill in the necessary information (work status, salary information).
- Submit all application documents to your health insurance society or the Japan Health Insurance Association.
- After review, if approved for payment, the funds will be transferred to your designated account.
Required Documents
| Document | Who Fills It Out |
|---|---|
| Sickness and Injury Allowance Application Form (Applicant's section) | Applicant |
| Section for Medical Practitioner (Opinion Letter) | Doctor |
| Section for Employer | Employer |
Points to Note When Applying
- Applications are generally made for each period of leave for medical treatment (multiple applications are possible).
- The statute of limitations is 2 years, so early application is recommended.
- For detailed conditions and amounts, it is most reliable to confirm with your health insurance society.
Relationship with Other Benefits
| System | Relationship with Sickness and Injury Allowance |
|---|---|
| Paid leave | During paid leave, salary is paid, so that period is not eligible for sickness and injury allowance (if salary is higher). |
| Salary from company | If salary is being paid, only the difference (if less than the sickness and injury allowance) may be paid. |
| Unemployment insurance (employment insurance) | Sickness and injury allowance is predicated on being "unable to work," so simultaneous receipt is generally not possible. |
| Disability pension | If symptoms are prolonged and exceed the sickness and injury allowance payment period (maximum 1 year and 6 months), a switch may be considered. |
When multiple systems are involved, the total amount received and the procedures will vary depending on which system is used and at what timing. If you are unsure, please consider consulting with a specialist such as a health insurance society or a social insurance labor consultant.
For consultations regarding a doctor's opinion, please feel free to contact us via LINE first.
Consult on Official LINEFrequently Asked Questions
Sickness and injury allowance is for those enrolled in health insurance (company health insurance societies, Japan Health Insurance Association), and National Health Insurance generally does not have this system.
It depends on the content of the examination. Our clinic can also accommodate this, so please consult us during your examination.
During paid leave, salary is paid, so that period tends to be ineligible for sickness and injury allowance. Generally, the process is to consider applying for sickness and injury allowance after paid leave is exhausted, from the period of unpaid medical leave. Please confirm details with your workplace's 담당 department.
Since it is calculated based on the average standard monthly remuneration for the 12 months prior to the start of payment, the amount is generally constant during the payment period.
For payments due to the same illness or injury, there is a cumulative maximum of 1 year and 6 months. Even if you return to work in between, if it's the same illness or injury, the periods are cumulative, so you need to check if there is any remaining eligible payment period. Please confirm details with your health insurance society.
