Typical occasions to use health insurance in treating traffic accident injury

There are two ways of treating injury in Japanese hospitals: self-pay care and health insurance care. Self-pay care needs you to pay full of medical expenses, while health insurance care needs you to pay only 30% of the medical expenses. Normally, we apply health insurance care for treating illness and injury because of the cheaper treatment expenses. However, treatment ways and drugs used in health insurance care have limitations according to the kinds of illness, while self-pay care offers more flexible and forefront treatment than health insurance care. Therefore, when treating traffic accident injury, applying self-pay care is a general option so that patients can recover as soon as possible using the forefront ways for treatment. Although its treatment expense is more expensive than health insurance care, it’s not a problem for patients if insurance companies bear the payment. However, depending on the situation, there are some cases where applying health insurance care is much more reasonable for traffic accident victims. In this article, we introduce four occasions we recommend using health insurance even for treating traffic accident injury. 

Health Insurance

The insurance company stopped paying medical expenses

If the responsible party in a traffic accident purchases voluntary insurance in addition to CALI, the voluntary insurance company generally bears your medical expense. In many cases, they directly pay it with your hospital so that you don’t need to pay for it yourself. However, on some occasions, they stop payment and you have to start payment by yourself. For example, the treatment term becomes longer than they expected, or the medical expenses become higher than the limited amount of CALI.

If you want to continue the treatment even though the voluntary insurance company stops paying medical expenses, you have to pay it by yourself. The medical expenses you tentatively bear might likely be paid back to you after all the processes from the voluntary insurance company. However, if the tentative payment of medical expenses is your big burden, you’d better think to use health insurance for continuing your treatment.   

A responsible party is without voluntary insurance

Responsible parties have a legal obligation to bear the medical treatment expenses for traffic accident victims. To take responsibility, more than 70% of the people in Japan purchase voluntary insurance in addition to CALI. However, if the responsible party is not with voluntary insurance but only with CALI, you might have to pay part of medical expenses which exceeds the limitation of CALI. In this case, it is wise to use your health insurance so that you can lower the cost you have to bear.

A responsible party is even without CALI, or you’re a hit-and-run victim

If a responsible party is without CALI, such a person usually has no financial ability to compensate for any of the losses. So, in this case, we recommend using health insurance for your traffic accident injury so that you can lower the medical cost. When without CALI, you can apply for compensation provided by the Government Compensation Plan offering the same amount of compensation as CALI. But they don’t compensate self-pay care, but only compensate health insurance care. So, also in this regard, you had better use your health insurance for treatment.

The same can be said to a hit-and-run victim. Although the Government Compensation Plan offers the victim the same compensation as CALI, their compensation is limited to health insurance care.

You’re also negligent in the traffic accident

The total amount of compensation you bear depends on your percentage of negligence in traffic accident cases in Japan. If you are 30% negligent in the accident, you have to bear 30% of the compensation for your total damages. So if you want to lower the cost you have to bear, using health insurance is wise. The following is an example.

If your total treatment fee is JPY1,000,000, and it is based on self-pay care. You have to bear JPY300,000 because of the 30% of negligence. However, if you use health insurance care, the treatment fee is a total of only JPY300,000. So, you have to pay only JPY90,000 as your burden.