Industrial Accident Compensation Insurance

Japanese: 労働者災害補償保険 - ろうどうしゃさいがいほしょうほけん（英語表記）Industrial Accident Compensation Insurance

A government-managed insurance system based on the Workmen's Accident Compensation Insurance Law (Law No. 50 of 1947). Abbreviated as Workmen's Accident Compensation Insurance. In addition to providing insurance benefits for injuries, illnesses, disabilities, and deaths caused by work-related reasons or commuting, the system aims to contribute to the promotion of workers' welfare by carrying out projects such as facilitating their rehabilitation into society.

[Hiromasa Shigeta]

System structure

Workmen's Accident Compensation Insurance applies to all businesses that employ workers, with the exception of non-working national and local government officials and seamen, and some agricultural, forestry and fishery businesses (temporary voluntary applicable businesses). In applicable businesses, the insurance relationship is automatically established at the business establishment level from the day the business starts, and all employees there become applicable workers, regardless of their employment type or length of employment. Insurance benefits do not require negligence on the part of the employer, and the only requirement is that the injury or illness is work-related. Insurance benefits, that is, the work of determining whether an injury is work-related, are carried out by the Labor Standards Inspection Office, but those who are dissatisfied with the decision can request an examination from the Workmen's Accident Compensation Insurance Examiner at the Prefectural Labor Bureau, and those who are further dissatisfied can request a reexamination from the Labor Insurance Review Board at the Ministry of Health, Labor and Welfare. The operating costs of the Workmen's Accident Compensation Insurance business are mainly covered by insurance premiums paid in full by the employer, but the insurance premium rate is determined for each type of business, taking into account factors such as the incidence of accidents. In addition, for medium-sized and larger businesses, a merit system has been established that increases or decreases insurance premium rates for each individual business depending on the past occurrence of disasters, with the aim of encouraging employers to make efforts to prevent disasters.

[Hiromasa Shigeta]

Benefit details

There are eight types of insurance benefits: medical compensation benefits, which are basically medical benefits in kind, absence compensation benefits, which are paid from the fourth day of absence from work for medical treatment and not receiving wages, injury and illness compensation pension, which is paid if the injury or illness has not been cured after one year and six months has passed since the start of treatment and the employee falls under a certain injury and illness grade, disability compensation benefits (pension or lump sum) paid if the employee is left with a certain degree of physical disability when the injury or illness is cured, nursing care compensation benefits paid to recipients of disability compensation pension or injury and illness compensation pension insurance who have a certain degree of disability and are receiving nursing care, secondary health examination benefits when abnormalities are found in blood pressure, blood sugar, waist circumference, BMI, etc. in the most recent regular health examination (primary health examination) conducted by the employer, and survivor compensation benefits (pension or lump sum) and funeral expenses paid in the event of death in the course of work. There are also special benefits to supplement each of the benefits. Of the above, the amounts of the four types of benefits excluding medical treatment/nursing care compensation, secondary health examination benefits, and funeral expenses are all calculated as a number of days or a percentage of the basic daily benefit amount, and the basic daily benefit amount is set as the average wage as defined in Article 12 of the Labor Standards Act, that is, the average daily wage for the three months prior to the day the reason for calculation arose.

[Hiromasa Shigeta November 13, 2020]

There is also a sliding scale provision that adjusts the amount of benefits according to social changes in wage levels after the disaster occurs. In order to broadly recognize industrial accidents for double workers who have multiple jobs, the Workers' Accident Compensation Insurance Act was partially revised, and from September 2020 (Reiwa 2), a new system was introduced in which, if an employee has multiple jobs, the working hours of all workplaces are added up to determine whether they have died from overwork, and industrial accident compensation is paid based on the combined wages of multiple workplaces.

In addition to workers employed by companies, there is a special enrollment system that is open to freelancers and other workers in certain industries who are deemed to be prone to accidents and in need of protection. Enrollment is voluntary, and workers pay the insurance premiums themselves. The insured person sets a basic daily benefit amount of 3,500 to 25,000 yen in advance, which is multiplied by the insurance premium rate (5.2% to 0.3%) determined by the danger level of the job. Eligible workers include small and medium-sized business owners, private taxi drivers, construction workers, dangerous agricultural workers, workers engaged in specific tasks such as nursing care and housework support, and people working overseas. In response to the diversification of working styles, from April 2021, actors and other entertainment workers, animators, judo therapists, and elderly people working as freelancers under the start-up support measures were added, and from September of the same year, bicycle delivery workers and IT engineers were added.

[Editorial Department, January 21, 2022]

Social reintegration promotion projects

In addition to insurance benefits, there are provisions for projects to promote social reintegration and other activities to improve the welfare of workers. The main ones are:
(1) Establishment and operation of industrial accident hospitals, rehabilitation centers, etc.
(2) Provision of school support expenses, childcare support expenses, nursing care expenses, etc.
(3) Advance payment of unpaid wages following corporate bankruptcy
(4) Subsidies for industrial accident prevention projects
(5) Measures to promote industrial medicine are being implemented.

In addition, Workers' Accident Compensation Liability Insurance is available from private insurance companies to cover cases not covered by the Workers' Accident Compensation Insurance Act or to cover additional compensation.

[Hiromasa Shigeta]

"The Structure of Workers' Accident Insurance," 5th edition, edited by the Labor Standards Bureau, Ministry of Labor (1997, Small and Medium Enterprise Labor Welfare Association)" ▽ "All About Workers' Accident Insurance and Safety and Health, edited by Kishio Hohara et al. (1998, Yuhikaku)" ▽ "Interesting and Easy-to-Understand Workers' Accident Insurance: Its Practical Aspects and Practice," written by Iwaki Ichiro (1999, Nihon Horei)" ▽ "Aiming for New Developments in the Workers' Accident Insurance Business," edited by the Management and Coordination Agency Administrative Inspection Bureau (2000, Printing Bureau, Ministry of Finance)" ▽ "Recent Issues and Developments in the Workers' Accident Insurance System, Latest," edited by the Labor Standards Bureau, Ministry of Health, Labor and Welfare (2003, Nikkan Labor News Agency)" ▽ "Workers' Accident Insurance Practical Course Explained by a Former Ministry of Health, Labor and Welfare Administrative Officer," revised edition, written by Takahashi Ken (2019, Nihon Horei)" ▽ "Collection of Laws Related to Workers' Accident Insurance, various years' editions, edited and published by the Labor Newspaper Company"

Source: Shogakukan Encyclopedia Nipponica About Encyclopedia Nipponica Information | Legend

Japanese:

労働者災害補償保険法（昭和22年法律第50号）に基づく政府管掌の保険制度。略称、労災保険。業務上の事由または通勤による労働者の負傷、疾病、障害、死亡に対して保険給付を行うほか、社会復帰促進等事業を行うことによって労働者の福祉増進に寄与することを目的としている。

［重田博正］

制度の仕組み

労災保険は、非現業の国家および地方公務員と船員、一部の農林水産業（暫定任意適用事業）を例外として、労働者を使用する事業にはすべて適用される。適用事業においては、その事業開始の日をもって事業所単位で自動的に保険関係が成立し、そこで働く者は、雇用形態や雇用期間の長さなどを問わずすべてが適用労働者となる。保険給付には、使用者側の過失の有無は問題とされず、ただその負傷や疾病などが業務上のものであることのみが要件とされる。保険給付つまり業務上認定の事務は労働基準監督署が行うが、その決定に不服がある者は都道府県労働局に置かれている労働者災害補償保険審査官に対し審査請求をすることができ、さらに不服のある者は、厚生労働省に置かれている労働保険審査会に対して再審査請求をすることができる。労災保険事業の運営費用は事業主が全額負担する保険料によっておもにまかなわれるが、保険料率は災害発生率などを考慮して事業の種類ごとに決められている。また中規模以上の事業については、事業主の災害防止努力を促進するねらいから、個々の事業ごとに、過去の災害発生状況に応じて保険料率の増減を行うメリット制が設けられている。

［重田博正］

給付内容

保険給付の種類としては、医療の現物給付を原則とする療養補償給付、療養のため休業し賃金を受けなかった日の4日目から支給される休業補償給付、療養開始後1年6か月を経過した以後において負傷や疾病が治っておらず、かつ一定の傷病等級に該当する場合に支給される傷病補償年金、負傷または疾病が治ったとき身体に一定の障害が残った場合に支給される障害補償給付（年金または一時金）、障害補償年金または傷病補償年金保険受給者のうち一定の障害があり介護を受けている場合に支給される介護補償給付、事業主が行った直近の定期健康診断（一次健康診断）等で血圧や血糖、腹囲、BMI等に異常の所見があると診断された際の二次健康診断等給付、そして業務上の死亡に対して支給される遺族補償給付（年金または一時金）と葬祭料の8種がある。またそれぞれの給付を補足する形で特別支給金がある。以上のうち療養・介護補償、二次健康診断等給付、葬祭料を除く4種の給付額はすべて給付基礎日額の何日分とか何パーセントという形で算定されるが、その基礎日額には労働基準法第12条に定める平均賃金、つまり算定事由が生じた日前3か月間の平均賃金日額があてられる。

［重田博正　2020年11月13日］

　なお、災害発生時以降の賃金水準の社会的変動に応じて給付額を改正するスライド制の規定も設けられている。兼業や副業をしているダブルワーカーの労災を広く認定するため、労働者災害補償保険法が一部改正され、2020年（令和2）9月から、仕事をかけ持ちしている場合、すべての勤務先の労働時間を合算して過労死などを判断する新制度が導入されて、複数事業所の賃金合算額をベースに労災保険を給付するようになった。

　また、企業などに雇われた労働者以外に、フリーランスなど、事故にあいやすく「保護が必要」と判断された一部業種に限って加入できる特別加入制度がある。加入は任意で、働き手が自ら保険料を負担する。保険料は、加入者があらかじめ3500円～2万5000円の給付基礎日額を設定し、これに仕事の危険度によって決まる保険料率（5.2％～0.3％）を乗じて決める。対象は中小事業主、個人タクシー運転手、建設業の一人親方、危険を伴う農作業、介護や家事支援などの特定作業従事者、海外赴任者らで、働き方の多様化にあわせ、2021年4月から俳優ら芸能従事者、アニメーター、柔道整復師、創業支援等措置に基づいてフリーランスとして働く高齢者を加え、同9月からは自転車を使用する配達員、ITエンジニアを加えた。

［編集部　2022年1月21日］

社会復帰促進等事業

保険給付と相まって労働者の福祉増進のために社会復帰促進等事業の規定がある。そのおもなものとして、
(1)労災病院、リハビリテーションセンターなどの設置・運営
(2)就学援護費、保育援護費、介護料などの支給
(3)企業倒産に伴う未払い賃金の立替払い事業
(4)労災防止事業に対する補助金交付
(5)産業医学振興対策
などが行われている。

　なお、労働者災害補償保険法の適用外のケースや上乗せ補償を担保するなどの民間保険会社提供の保険として、労働者災害補償責任保険がある。

［重田博正］

『労働省労働基準局労災管理課編『労災保険の仕組み』第5版（1997・中小企業労働福祉協会）』▽『保原喜志夫他編『労災保険・安全衛生のすべて』（1998・有斐閣）』▽『岩城猪一郎著『おもしろくてよくわかる労災保険の話と実務』（1999・日本法令）』▽『総務庁行政監察局編『労災保険事業の新たな展開を目指して』（2000・大蔵省印刷局）』▽『厚生労働省労働基準局編『最近における労災保険制度の課題と展開　最新』（2003・日刊労働通信社）』▽『高橋健著『元厚生労働事務官が解説する　労災保険実務講座』改訂版（2019・日本法令）』▽『労働新聞社編・刊『労災保険関係法令集』各年版』