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Traffic or other accidents

When a member or dependent has got injured by a third party in a traffic accident, the injured person may use the Membership Card for medical treatment except a case of accident during work or commute. We will temporarily bear the medical costs which shall be attributable to the third party and will later file a claim for compensation against the party (or, the party’s auto liability insurance etc.). The injured person must contact us and submit the following documents so that we can take necessary procedures.

Prior notice

When an accident has occurred, the injured person must immediately contact us before using the Membership Card for medical treatment.

Documents to submit

Submit the following documents, with which we will file a claim for the medical expenses against the other party (the party’s insurance company).

  1. Liability claim
  2. Circumstantial report
  3. Original copy of Certificate for traffic accident (as an accident causing injury)
  4. Circumstantial report of the accident
  5. Details of the insurance contract
  6. Promissory letter signed by the other party
  7. Letter of awareness
  8. Results of treatment of the injury caused by the other party
    (Submit when you/dependent have recovered from the injury or the symptom has been stabilized.)

Note: Documents numbered 3 to 5 are required only for the case of traffic accident.

Out-of-court settlement

When a settlement is privately reached through reciprocal concessions between the parties, it will become legally effective and binding according to Article 695 of the Civil Code.
If a member or dependent should receive compensation from the counterparty including the amount of medical expenses which we have paid on behalf of the member or dependent, we might lose a legitimate right to seek compensation.
In this case, the member may be requested to returned the medical expense.
Therefore, when entering into a private settlement, a member or dependent must be careful not to lose our right to seek compensation from the counterparty, and also confirm in writing that the other party will be responsible for paying back the partial advances (e.g. insurance-covered medical fees) paid by us upon request.

Reporting is required in the following instances as well.

  1. One-car accident where a member or dependent was aboard or driving.
  2. Fender-bender with a parked car
  3. Car crash by crossing the center line
  4. Car collision with another car, a bicycle or a pedestrian
  5. Skiing collision
  6. Injury by a flying golf ball
  7. Attack by a pet (e.g. bite by a neighbor’s dog)
  8. Injury due to fighting or violence
  9. Food poisoning at a hotel or inn

Note: An accident or damage caused by a member or dependent shall also be reported to us when the Membership Card is used for medical treatment.

Benefit will not be provided in the following cases.

  1. Illness or injury caused as a result of intentional misconduct or gross negligence by a member or dependent
  2. Neglect of instructions provided by a doctor or us without reasonable justification

Injury or illness during work or commute is within the scope of industrial accident compensation insurance.

In this case, you cannot use the Membership Card for medical treatment. You must tell at the medical institution that you became ill or injured when you were working or commuting. You must also report to the relevant Labor Standard Inspection Office through your school office. When the industrial accident compensation insurance is applicable, medical expenses will be covered by the insurance instead of us.