Industrial Accident Compensation Insurance Act

Transcription

1 Industrial Accident Compensation Insurance Act (Act No. 50 of April 7, 1947) Contents Chapter I General Provisions (Article 1 to Article 5) Chapter II Establishment and Extinguishment of Insurance Relationships (Article 6) Chapter III Insurance Benefits Section 1 General Rules (Article 7 to Article 12-7) Section 2 Insurance Benefits in Respect of Employment Injuries (Article 12-8 to Article 20) Section 3 Insurance Benefits in Respect of Commuting Injuries (Article 21 to Article 25) Section 4 Follow-up Medical Examination Benefits (Article 26 to Article 28) Chapter III-2 Social Rehabilitation Promotion Services (Article 29) Chapter IV Imposition of Expenses (Article 30 to Article 32) Chapter IV-2 Special Insurance (Article 33 to Article 37) Chapter V Appeal and Lawsuits (Article 38 to Article 41) Chapter VI Miscellaneous Provisions (Article 42 to Article 50) Chapter VII Penal Provisions (Article 51 to Article 54) Supplementary Provisions Chapter I General Provisions Article 1 The purposes of the industrial accident compensation insurance are to grant necessary insurance benefits to workers in order to give them prompt and fair protection against injury, disease, disability or death or the like resulting from an employment-related cause or commuting, and to promote the social rehabilitation of workers who have suffered an injury or disease from an employment-related cause or commuting, assist those workers and their surviving family members and secure the safety and health of workers or the like, thereby contributing to the promotion of the welfare of such workers. Article 2 The government shall administer industrial accident compensation insurance. Article 2-2 Industrial accident compensation insurance, in order to achieve the purpose set forth in Article 1, shall cover social rehabilitation promotion services in addition to granting insurance benefits to workers for their injury, 1

2 disease, disability or death or the like resulting from an employment-related cause or commuting. Article 3 (1) In this Act, businesses that employ a worker or workers shall be covered businesses. (2) Notwithstanding the provision of the preceding paragraph, this Act shall not apply to businesses managed directly by the State, businesses managed by public agencies (excluding the businesses listed in Appended Table 1 of the Labor Standards Act (Act No. 49 of 1947)) and persons insured by mariners' insurance under the provision of Article 17 of the Mariners' Insurance Act (Act No. 73 of 1939). Article 4 Deleted Article 5 Cabinet Orders and Ordinances of the Ministry of Health, Labour and Welfare under this Act and Cabinet Orders and Ordinances of the Ministry of Health, Labour and Welfare (limited to those pertaining to industrial accident compensation insurance services) under the Act on the Collection of Premiums on Labor Insurance (Act No. 84 of 1969; hereinafter referred to as the "Premiums Collection Act") shall be established after hearing opinions from the Labour Policy Council as to drafts thereof. Chapter II Establishment and Extinguishment of Insurance Relationships Article 6 The establishment and extinguishment of insurance relationships shall be governed by the provisions of the Premiums Collection Act. Chapter III Insurance Benefits Section 1 General Rules Article 7 (1) The insurance benefits under this Act shall be the following: (i) insurance benefits in respect of injury, disease, disability or death of workers resulting from an employment-related cause (hereinafter referred to as an "employment injury"); (ii) insurance benefits in respect of injury, disease, disability or death of workers resulting from commuting (hereinafter referred to as a "commuting injury"); and (iii) follow-up medical examination benefits (2) The commuting set forth in item (ii) of the preceding paragraph shall mean any of the journey listed in the following and made by a worker in connection with his/her employment by a reasonable route and means, excluding 2

3 commuting which has the nature of the performance of duties: (i) round-trip between the worker's residence and workplace; (ii) journey from the worker's workplace to another workplace as specified by an Ordinance of the Ministry of Health, Labour and Welfare; and (iii) journey between the worker's residences that precedes or follows the round-trip listed in item (i) (limited to a journey satisfying the requirements specified by an Ordinance of the Ministry of Health, Labour and Welfare (3) Where a worker has deviated from the route of the journey listed in each item of the preceding paragraph or has stopped en route during any journey listed in each item of said paragraph, such deviation or stoppage en route and any subsequent journey listed in each item of said paragraph shall not constitute commuting as set forth in paragraph (1), item (ii); provided, however, that this shall not apply where said deviation or stoppage en route is the minimum required for carrying out an act necessary in daily life as specified by an Ordinance of the Ministry of Health, Labour and Welfare due to unavoidable circumstances, except during the period of said deviation or stoppage en route. Article 8 (1) The basic daily benefit amount shall be the amount equivalent to the average wage set forth in Article 12 of the Labor Standards Act. In this case, the day on which the grounds for calculation of the average wage arose as set forth in paragraph (1) of said Article shall be the day on which the accident which was the cause of injury or death as prescribed in paragraph (1), item (i) or item (ii) of the preceding Article arose, or the day on which the occurrence of a disease prescribed in item (i) or item (ii) of said paragraph was confirmed by diagnosis (hereinafter referred to as "the day of the occurrence of the grounds for calculation"). (2) When it is deemed inappropriate to take the amount equivalent to the average wage set forth in Article 12 of the Labor Standards Act as the basic daily benefit amount, the basic daily benefit amount shall be the amount calculated by the government pursuant to the provisions of an Ordinance of the Ministry of Health, Labour and Welfare, notwithstanding the provision of the preceding paragraph. Article 8-2 (1) The basic daily benefit amount used as the basis for calculating temporary absence from work compensation benefits or temporary absence from work benefits (hereinafter referred to as the "temporary absence from work compensation benefits, etc." in this Article) (this amount shall hereinafter be referred to as "basic daily temporary absence from work benefit amount" in this Article) shall be provided as follows: (i) With regard to temporary absence from work compensation benefits, etc. other than the temporary absence from work compensation benefits, etc. 3

4 prescribed in the following item, the amount calculated as the basic daily benefit amount pursuant to the provision of the preceding Article shall be the basic daily temporary absence from work benefit amount. (ii) Where the average salary amount (meaning the average monthly amount of salary per worker calculated pursuant to the provisions of an Ordinance of the Ministry of Health, Labour and Welfare based on the amount of salary paid regularly every month according to the Monthly Labor Survey prepared by the Ministry of Health, Labour and Welfare; hereinafter the same shall apply in this item) per period categorized as January to March, April to June, July to September, and October to December (hereinafter referred to as a "quarter" in this Article) has exceeded 110 percent or fallen below 90 percent of the average salary for the quarter containing the day of the occurrence of the grounds for calculation (in cases where the amount calculated pursuant to the provision of this item (hereinafter referred to as the "revised daily amount" in this item) is regarded as the basic daily temporary absence from work benefit amount, the quarter two quarters before the first quarter for which said revised basic daily amount is to be used as the basis for calculating the amount of temporary absence from work compensation benefits, etc.), in relation to the temporary absence from work compensation benefits, etc. for which grounds for payment arise on or after the first day contained in the quarter two quarters after the quarter in which such increase or decrease has occurred, the basic daily temporary absence from work benefit amount shall be the amount obtained by multiplying the amount calculated as the basic daily benefit amount pursuant to the provision of the preceding Article (in cases where a revised daily amount is regarded as the basic daily temporary absence from work benefit amount, said revised daily amount) by a rate specified by the Minister of Health, Labour and Welfare based on that rate of increase or decrease. (2) Where the day on which grounds for payment of temporary absence from work compensation benefits, etc. arise is the day on which one year and six months have elapsed from the day of the commencement of medical treatment pertaining to said temporary absence from work compensation benefits, etc. or any subsequent day, if any of the cases listed in the following items apply, the amount specified in the respective items shall be the basic daily temporary absence from work benefit amount, notwithstanding the provision of the preceding paragraph: (i) where the amount calculated as the basic daily temporary absence from work benefit amount pursuant to the provision of the preceding paragraph is less than the minimum amount of the basic daily temporary absence from work benefit amount specified by the Minister of Health, Labour and Welfare for each age bracket specified by an Ordinance of the Ministry of Health, 4

5 Labour and Welfare (hereinafter simply referred to as the "age bracket" in this Article), which pertains to the age bracket to which a worker who is to receive said basic daily temporary absence from work compensation benefits, etc. belongs as of the first day of the quarter containing the day on which the grounds for the payment of said basic daily temporary absence from work compensation benefits, etc. arose (hereinafter referred to as the "standard day" in the following item): the amount pertaining to said age bracket; or (ii) where the amount calculated as the basic daily temporary absence from work benefit amount pursuant to the provision of the preceding paragraph exceeds the maximum amount of the basic daily temporary absence from work benefit amount specified by the Minister of Health, Labour and Welfare for each age bracket, which pertains to the age bracket to which a worker who is to receive said temporary absence from work compensation benefits, etc., belongs as of the standard day: the amount pertaining to said age bracket (3) The amount specified by the Minister of Health, Labour and Welfare as set forth in item (i) of the preceding paragraph shall be specified each year for each age bracket pursuant to the provisions of an Ordinance of the Ministry of Health, Labour and Welfare in consideration of the employment conditions and other circumstances concerning workers in each age bracket, by classifying all workers who belong to said age bracket into twenty categories in accordance with the level of monthly wages that they receive (hereinafter referred to as "monthly wages" in this paragraph) and applying the highest monthly wage received by the workers belonging to the category of the lowest monthly wage as the basis for the calculation of such amount. (4) The provision of the preceding paragraph shall apply mutatis mutandis to the amount specified by the Minister of Health, Labour and Welfare as set forth in paragraph (2), item (ii). In this case, the term "pertaining to the lowest monthly wage" in the preceding paragraph shall be deemed to be replaced with "immediately below the category of the highest monthly wage". Article 8-3 (1) The basic daily benefit amount used as the basis for calculating insurance benefits in pension form (hereinafter referred to as the "basic daily pension benefit amount" in this Article) shall be provided as follows; (i) With regard to insurance benefits in pension form to be paid in respect of the period until July of the fiscal year (meaning a period from April l to March 31 of the following year; the same shall apply hereinafter) two years after the fiscal year containing the day of the occurrence of the grounds for calculation, the amount calculated as the basic daily benefit amount pursuant to the provision of Article 8 shall be the basic daily pension benefit amount. 5

6 (ii) With regard to insurance benefits in pension form to be paid in respect of the period from August of the fiscal year two years after the fiscal year containing the day of the occurrence of the grounds for calculation, the amount obtained by multiplying the amount calculated as the basic daily benefit amount pursuant to the provision of Article 8 by a rate specified by the Minister of Health, Labour and Welfare based on the rate obtained by dividing the average salary (meaning the average amount of salary per worker calculated pursuant to the provisions of an Ordinance of the Ministry of Health, Labour and Welfare based on the amount of salary paid regularly every month according to the Monthly Labor Survey prepared by the Ministry of Health, Labour and Welfare; hereinafter the same shall apply in this item and Article 16-6, paragraph (2)) for the fiscal year one year before the fiscal year containing the month for which insurance benefits in pension form are to be paid (where said month falls on the months from April to July, the fiscal year two years before), by the average salary for the fiscal year containing the day of the occurrence of the grounds of calculation, shall be the basic daily pension benefit amount. (2) The provisions of paragraphs (2) to (4) of the preceding Article shall apply mutatis mutandis to the basic daily pension benefit amount. In this case, the term "the preceding paragraph" in paragraph (2) of said Article shall be deemed to be replaced with "paragraph (1) of the following Article"; in paragraph (2), item (i), the term "temporary absence from work compensation benefits, etc." shall be deemed to be replaced with "insurance benefits in pension form", the term "the day on which the grounds for payment arose", shall be deemed to be replaced with "the month for which payment is to be made," the term "the first day of the quarter containing the day... arose (hereinafter referred to as the "standard day" in the following item)" shall be deemed to be replaced with "August 1 of the fiscal year containing the day... arose (in cases where said month falls on the months from April to July, August 1 of the fiscal year one year before such fiscal year; hereinafter referred to as the "standard day" in the this paragraph)," and the term "age of a worker... (hereinafter referred to as the "standard day" in the following item)" shall be deemed to be replaced with "age of a worker... (hereinafter referred to as the "standard day" in the following item; in cases where a compensation pension for surviving family or a pension for surviving family is to be paid, the age of a worker who is to receive such payment as of the standard day obtained by making the calculation on the assumption that the death of the worker pertaining to the grounds for making said payment has not occurred; hereinafter the same shall apply in the following item)"; and the term "temporary absence from work compensation benefits, etc." in paragraph (2), item (ii) shall be deemed to be replaced with "insurance benefits in pension 6

7 form". Article 8-4 The provision of paragraph (1) of the preceding Article shall apply mutatis mutandis to the basic daily benefit amount used as the basis for calculating the disability compensation lump sum payment, lump sum compensation for surviving family, disability lump sum payment or lump sum payment for surviving family. In this case, the term "paid in respect of the period" and "the month for which insurance benefits in pension form are to be paid" in said paragraph shall be respectively deemed to be replaced with "for which grounds for payment arose in" and "the month in which grounds for the payment of insurance benefits in pension form arose". Article 8-5 When the basic daily benefit amount includes a fraction of less than one yen, such fraction shall be rounded up to a whole yen. Article 9 (1) Payment of insurance benefits in pension form shall commence in the month following the month in which the grounds for payment arose and shall terminate in the month in which the right to receive payment is extinguished. (2) If grounds for suspending payment have arisen, insurance benefits in pension form shall not be paid from the month following the month in which said grounds arose until the month in which the grounds cease to exist. (3) Insurance benefits in pension form shall be paid six times a year, namely in February, April, June, August, October and December of each year, with each payment being for the period until the end of the previous month; provided, however, that in cases where the right to receive the benefits has been extinguished, the insurance benefits in pension form for the relevant period shall be paid even where the month is not a payment month. Article 10 Where it is not known for three months whether a worker who was on board a vessel when it sank, capsized, was lost or went missing or who was on board a vessel and went missing during its navigation is dead or alive, or where the death of such worker becomes apparent within three months but the time of death is not known, said worker shall, for the purpose of the application of the provisions relating to the payment of compensation benefits for surviving family, funeral rites benefits, benefits for surviving family and funeral benefits, be presumed to have died on the day on which the vessel sank, capsized, was lost or went missing or on the day on which the worker went missing. The same shall apply where it is not known for three months whether a worker who was on board an aircraft when it crashed, was lost or went missing or who was on board an aircraft and went missing during its flight is 7

8 dead or alive, or where the death of such worker becomes apparent within three months but the time of death is not known. Article 11 (1) Where a person entitled to the right to receive insurance benefits under this Act has died and any part of the insurance benefits payable to the deceased person remains unpaid to said person, his/her spouse (including a person who has not made a notification of marriage but has been in a de facto marital relationship with the deceased person; the same shall apply hereinafter), children, parents, grandchildren, grandparents or siblings who shared living expenses with the deceased person at the time of his/her death (in the case of the compensation pension for surviving family, other surviving family members eligible to receive said compensation pension for surviving family, and in the case of the pension for surviving family, other surviving family members eligible to receive said pension for surviving family) may claim payment of the unpaid insurance benefits in their own names. (2) In the case referred to in the preceding paragraph, if the deceased person had not claimed payment of insurance benefits before his/her death, those persons prescribed in said paragraph may claim payment of the insurance benefits in their own names. (3) The order of priority of those who are to receive any unpaid insurance benefits shall be in accordance with the order prescribed in paragraph (1) (in the case of the compensation pension for surviving family, the order prescribed in Article 16-2, paragraph (3) shall apply, and in the case of the pension for surviving family, the order prescribed in Article 16-2, paragraph (3) as applied mutatis mutandis pursuant to Article 22-4, paragraph (3) shall apply). (4) Where there are two or more persons who hold the same rank in the order of priority of persons who are to receive any unpaid insurance benefits, a claim made by one of them shall be deemed to have been made on behalf of all of them in respect of the total amount, and a payment made to one of them shall be deemed to have been made to all of them. Article 12 (1) When, notwithstanding that grounds have arisen for suspending the payment of insurance benefits in pension form, any part of the insurance benefits in pension form has been paid for a period for which the payment should have been suspended, the insurance benefits which have been paid may be deemed to be a down payment on the insurance benefits in pension form which are to be paid subsequently. When, notwithstanding that grounds have arisen for reducing and revising the amount of insurance benefits in pension form, the insurance benefits in pension form have been paid without reduction for a period from the month following the month in which the grounds arose, the same shall apply to such portion by which said insurance benefits in 8

9 pension form should have been reduced. (2) Where a worker entitled to the right to receive insurance benefits in pension form (excluding the compensation pension for surviving family and the pension for surviving family; hereinafter referred to as "Pension B" in this paragraph) has become entitled to the right to receive other insurance benefits in pension form (excluding the compensation pension for surviving family and the pension for surviving family; hereinafter referred to as "Pension A" in this paragraph) in respect of the same injury or disease resulting from an employment-related cause or commuting (hereinafter referred to as "the same injury or disease" in this Article), and the right to receive Pension B has been extinguished, if Pension B has been paid for a period from the month following the month in which the right thereto was extinguished, that payment of Pension B shall be deemed to be a down payment on Pension A. Where a worker entitled to the right to receive insurance benefits in pension form (excluding the compensation pension for surviving family and the pension for surviving family) has become entitled to the right to receive a temporary absence from work compensation benefit or temporary absence from work benefits, or disability compensation lump sum payment or disability lump sum payment in respect of the same injury or disease, and the right to receive said insurance benefits in pension form has been extinguished, the same shall apply if said insurance benefits in pension form have been paid for a period from the month following the month in which the right thereto was extinguished. (3) Where a worker receiving temporary absence from work compensation benefits or temporary absence from work benefits has become entitled to the right to receive a disability compensation benefit or an injury and disease compensation pension or disability benefits or an injury and disease pension in respect of the same injury or disease, and it has been decided not to pay temporary absence from work compensation benefits or temporary absence from work benefits, if the worker continues to be paid temporary absence from work compensation benefits or temporary absence from work benefits thereafter, such temporary absence from work compensation benefits or temporary absence from work benefits paid shall be deemed to be a down payment on said disability compensation benefits, injury and disease compensation pension, disability benefits or injury and disease pension. Article 12-2 Where a person entitled to the right to receive insurance benefits in pension form has died, and despite the extinguishment of that right as a result of the death of said person, insurance benefits in pension form have been paid by mistake for a period from the month following the month containing the day of the death, if there are any insurance benefits payable to the person who is obliged to repay the debt pertaining to the claim for refund arising from such 9

10 payment by mistake (hereinafter referred to as the "claim for refund" in this Article), the amount of money paid as said insurance benefits may be appropriated to the amount of the claim for refund arising from said payment by mistake, pursuant to the provisions of an Ordinance of the Ministry of Health, Labour and Welfare. Article (1) When a worker has intentionally caused an injury, disease, disability or death or an accident that was the direct cause thereof, the government shall not pay insurance benefits. (2) When a worker has, by an intentional criminal act or gross negligence or by not following directions as to medical treatment without any justifiable grounds, caused an injury, disease, disability or death or an accident that was the cause thereof, or worsened the degree of injury, disease or disability or hindered his/her recovery therefrom, the government may decide not to pay the whole or a part of the insurance benefits. Article 12-3 (1) When a person has received insurance benefits by deception or other wrongful means, the government may collect from that person the whole or a part of the amount equivalent to the expenses incurred in paying the insurance benefits. (2) In the cases referred to in the preceding paragraph, when the payment of the insurance benefits was due to a false report or certification by an employer (in cases where a prime contractor is deemed to be an employer pursuant to the provisions of Article 8, paragraph (1) or paragraph (2) of the Premiums Collection Act, said prime contractor; the same shall apply hereinafter), the government may order the employer to pay the money to be collected as set forth in the preceding paragraph jointly and severally with the person who has received the insurance benefit. (3) The provisions of Article 26, Article 28, Article 29 and Article 41 of the Premiums Collection Act shall apply mutatis mutandis to the money to be collected pursuant to the provisions of the preceding two paragraphs. Article 12-4 (1) When the government has paid insurance benefits in cases where an accident which is the cause of payment of insurance benefits arose from an act by a third party, the government shall acquire a claim for damages held by the person who has received the insurance benefits against the third party, up to the limit of the amount of the benefits paid. (2) In the cases referred to in the preceding paragraph, when the person who are to receive insurance benefits has received damages from the third party on the same grounds, the government may decide not to pay the insurance benefits, up to the limit of the value of those damages. 10

11 Article 12-5 (1) The right to receive insurance benefits shall not be affected by the retirement of the worker. (2) The right to receive insurance benefits may not be transferred, offered as security or attached; provided, however, that this shall not apply where the right to receive insurance benefits in pension form is offered as security to the Welfare and Medical Service Agency pursuant to the provisions of the Welfare and Medical Service Agency Act (Act No. 166 of 2002). Article 12-6 Taxes and other public dues may not be imposed on the basis of money and goods received as payment of insurance benefits. Article 12-7 A person entitled to the right to receive insurance benefits shall, pursuant to the provisions of an Ordinance of the Ministry of Health, Labour and Welfare, make a notification to the government of the necessary matters specified by an Ordinance of the Ministry of Health, Labour and Welfare in respect of insurance benefits, or submit the necessary documents or other articles specified by an Ordinance of the Ministry of Health, Labour and Welfare in respect of insurance benefits. Section 2 Insurance Benefits in Respect of Employment Injuries Article 12-8 (1) The insurance benefits in respect of an employment injury set forth in Article 7, paragraph (1), item (i) shall be the insurance benefits listed in the following: (i) medical compensation benefits; (ii) temporary absence from work compensation benefits; (iii) disability compensation benefits; (iv) compensation benefits for surviving family; (v) funeral expenses; (vi) injury and disease compensation pension; and (vii) nursing care compensation benefits (2) The insurance benefits set forth in the preceding paragraph (excluding the injury and disease compensation pension and the nursing care compensation benefits) shall, where the grounds for accident compensation prescribed in Article 75 to Article 77, and Article 79 and Article 80 of the Labor Standards Act have arisen, be paid to a worker or surviving family members who are to receive compensation or to a person who conducts the funeral, based on their claims. (3) An injury and disease compensation pension shall be paid to a worker who suffered an injury or disease resulting from an employment-related cause when 11

12 he/she falls under all of the following items as of the day on which one year and six months have elapsed after the commencement of medical treatment pertaining to said injury or disease, or has come to fall under all of the following items after said day, and such payment shall be made for the period during which the relevant condition continues to exist: (i) said injury or disease has not healed or been cured; and (ii) the degree of disability due to said injury or disease falls under a grade of injury and disease specified by an Ordinance of the Ministry of Health, Labour and Welfare (4) Nursing care compensation benefits shall be paid to a worker who is entitled to the right to receive a disability compensation pension or an injury and disease compensation pension, based on his/her claim, when he/she is in a condition requiring constant or occasional nursing care and is receiving constant or occasional nursing care due to a disability where the disability is the grounds for the payment of that disability compensation pension or injury and disease compensation pension which the worker is entitled to the right to receive and where the disability is at the level specified by an Ordinance of the Ministry of Health, Labour and Welfare, and such payment shall be made for the period during which said nursing care is received (excluding the following periods): (i) the period during which the worker is admitted to a support facility for persons with disabilities prescribed in Article 5, paragraph (12) of the Services and Supports for Persons with Disabilities Act (Act No. 123 of 2005) (hereinafter referred to as a "support facility for persons with disabilities") (limited to cases where the worker receives care for daily life prescribed in paragraph (6) of said Article (hereinafter referred to as "care for daily life")); and (ii) the period during which the worker is admitted to a facility specified by the Minister of Health, Labour and Welfare as being equivalent to a support facility for persons with disabilities (limited to those where care for daily life is provided); and (iii) the period during which the worker is admitted to a hospital or clinic Article 13 (1) The medical compensation benefits shall be granted as benefits for medical treatment. (2) The scope of the benefits for medical treatment set forth in the preceding paragraph shall be as prescribed in the following items (limited to those considered necessary by the government): (i) medical examination; (ii) provision of medicines or therapeutic materials; (iii) medical treatment procedures, operations and other therapies; 12

13 (iv) management of home-based medical treatment and relevant help and other nursing care involved in such medical treatment; (v) admission to hospitals or clinics and relevant help and other nursing care involved in the medical treatment concerned; and (vi) transport (3) The government may, where it is difficult to grant the benefits for medical treatment set forth in paragraph (1) and in other cases specified by an Ordinance of the Ministry of Health, Labour and Welfare, pay the expenses of medical treatment in lieu of granting the benefits for medical treatment. Article 14 (1) The temporary absence from work compensation benefits shall be paid from the fourth day on which a worker fails to receive wages because of an inability to work due to medical treatment for an injury or disease resulting from an employment-related cause, and the benefit amount for one day shall be an amount equivalent to 60 percent of the basic daily benefit amount; provided, however, that the amount of the temporary absence from work compensation benefits for days on which a worker works for only a portion of the prescribed working hours due to medical treatment for an injury or disease resulting from an employment-related cause shall be an amount equivalent to 60 percent of the amount obtained by deducting the amount of the wages to be paid for said work from the basic daily benefit amount (in cases where the amount prescribed in Article 8-2, paragraph (2), item (ii) (hereinafter referred to as "the maximum amount" in this paragraph) is regarded as the basic daily benefit amount, the basic daily benefit amount to be paid on the assumption that the provision of said item does not apply) (in cases where the amount obtained by said deduction exceeds the maximum amount, the amount equivalent to the maximum amount). (2) When a worker who receives temporary absence from work compensation benefits is, on the same grounds, eligible to receive either a disability employee's pension under the provisions of the Employee's Pension Insurance Act (Act No. 115 of 1954) or a disability basic pension under the provisions of the National Pension Act (Act No. 141 of 1959), the amount of the temporary absence from work compensation benefits payable to said worker shall, notwithstanding the provision of the preceding paragraph, be the amount obtained by multiplying the amount set forth in said paragraph, in accordance with the provisions of items (i) to (iii) of Table 1, by the rate for injury and disease compensation pension amongst the rates specified by a Cabinet Order set forth in items (i) to (iii) of said table (in cases where such amount is less than the amount specified by a Cabinet Order, said amount specified by a Cabinet Order). 13

14 Article 14-2 No temporary absence from work compensation benefit shall be paid where a worker falls under any of the following items (limited to cases specified by an Ordinance of the Ministry of Health, Labour and Welfare): (i) where a worker is detained in a penal institution, workhouse or any other facility equivalent thereto; or (ii) where a worker is detained in a juvenile training school or any other facility equivalent thereto Article 15 (1) The disability compensation benefits shall be paid in the form of either a disability compensation pension or a disability compensation lump sum payment, in accordance with the grades of disability specified by an Ordinance of the Ministry of Health, Labour and Welfare. (2) The amounts of a disability compensation pension or a disability compensation lump sum payment shall be as prescribed respectively in Appended Table 1 or Appended Table 2. Article 15-2 Where there has been a change to the degree of the relevant degree of the disability of a worker receiving a disability compensation pension, and as a result of such change, said worker has come to fall under another grade of disability prescribed in Appended Table 1 or Appended Table 2, the government shall, pursuant to the provisions of an Ordinance of the Ministry of Health, Labour and Welfare, pay the disability compensation pension or disability compensation lump sum payment corresponding to the new grade of disability under which said worker now falls, and shall not pay the former disability compensation pension thereafter. Article 16 Compensation benefits for surviving family shall be paid in the form of either a compensation pension for surviving family or a lump sum compensation for surviving family. Article 16-2 (1) The surviving family members who are eligible to receive a compensation pension for surviving family shall be a worker's spouse, children, parents, grandchildren, grandparents, and siblings who were dependent on the worker's income at the time of his/her death; provided, however, that in the case of those other than a wife (including a person who has not made a notification of marriage but has been in a de facto marital relationship with the worker; the same shall apply hereinafter), this provision shall apply only where they have satisfied the requirements listed in any of the following items at the time of the worker's death: (i) in the case of a husband (including a person who has not made a notification of marriage but has been in a de facto marital relationship with the worker; 14

15 the same shall apply hereinafter), parents or grandparents: they are 60 years of age or more; (ii) in the case of children or grandchildren: March 31 has not been reached since they became 18 years of age; (iii) in the case of siblings: March 31 has not been reached since they became 18 years of age, or they are 60 years of age or more; or (iv) in the case of a husband, children, parents, grandchildren, grandparents, or siblings who do not fall under any of the requirements set forth in the preceding three items: they are disabled as specified by an Ordinance of the Ministry of Health, Labour and Welfare (2) When a child who was unborn at the time of a worker's death is born, the child shall, for the purpose of the application of the provision of the preceding paragraph, be deemed, from the time of his/her birth forward, as a child who was dependent on the worker's income at the time of the worker's death. (3) The order of priority of surviving family members who are to receive a compensation pension for surviving family shall be the spouse, children, parents, grandchildren, grandparents and siblings. Article 16-3 (1) The amount of a compensation pension for surviving family shall be the amount prescribed in Appended Table 1. (2) If there are two or more persons entitled to the right to receive a compensation pension for surviving family, the amount of the compensation pension for surviving family shall, notwithstanding the provision of the preceding paragraph, be the amount obtained by dividing the amount prescribed in Appended Table 1 by the number of persons concerned. (3) If there has been an increase or decrease in the number of the surviving family members which is to be used as the basis for calculating the amount of a compensation pension for surviving family, the amount of the compensation pension for surviving family shall be revised as from the month following the month in which the increase or decrease occurred. (4) Where the surviving family member who is entitled to the right to receive a compensation pension for surviving family is the worker's wife, and there are no other surviving family members eligible to receive the compensation pension for surviving family who share living expenses with the wife, if said wife comes to fall under any of the following items, the amount of the compensation pension for surviving family shall be revised as from the month following the month in which the wife fell under the respective items: (i) when the wife has reached the age of 55 (excluding cases where the wife is disabled as specified by an Ordinance of the Ministry of Health, Labour and Welfare set forth in Appended Table 1); (ii) when the wife has become disabled as specified by an Ordinance of the 15

16 Ministry of Health, Labour and Welfare set forth in Appended Table 1 or such circumstances have ceased to exist (excluding cases where the wife is 55 years of age or more) Article 16-4 (1) The right to receive a compensation pension for surviving family shall be extinguished when a surviving family member entitled to the right has come to fall under any of the following items. In this case, when there is no person holding the same rank in the order of priority but there is a person(s) holding a lower rank, the compensation pension for surviving family shall be paid to the person(s) who holds the next rank: (i) when the entitled surviving family member has died; (ii) when the entitled surviving family member has married (including cases where a notification of marriage has not been made but the surviving family member is in a de facto marital relationship); (iii) when the entitled surviving family member has been adopted by a person other than his/her lineal relative by blood or his/her lineal relative through marriage (including cases where a notification of adoption has not been made but the surviving family member is in a de facto adoptive relationship); (iv) when the entitled surviving family member's familial relationship to the deceased worker has been terminated by the dissolution of an adoptive relationship; (v) in the case of children, grandchildren or siblings, when the first March 31 that they experience after reaching the age of 18 ends (excluding cases where they have been disabled as specified by an Ordinance of the Ministry of Health, Labour and Welfare set forth in Article 16-2, paragraph (1), item (iv) continuously from the time of the death of the worker); or (vi) in the case of the worker's husband, children, parents, grandchildren, grandparents or siblings who are disabled as specified by an Ordinance of the Ministry of Health, Labour and Welfare set forth in Article 16-2, paragraph (1), item (iv), when such circumstances have ceased to exist (excluding cases where the worker's husband, parents or grandparents were 60 years of age or more at the time of the worker's death, where the worker's children or grandchildren have not experienced the first March 31 after reaching the age of 18, and where the worker's siblings have not experienced the first March 31 after reaching the age of 18 or they were 60 years of age or more at the time of the worker's death). (2) When a surviving family member eligible to receive a compensation pension for surviving family has come to fall under any of the items of the preceding paragraph, he/she shall cease to be a surviving family member eligible to receive the compensation pension for surviving family. 16

17 Article 16-5 (1) When the whereabouts of a person who is entitled to the right to receive a compensation pension for surviving family have been unknown for not less than one year, the payment of said compensation pension for surviving family shall be suspended for as long as those whereabouts are unknown, upon the application of a person who holds the same rank in the order of priority if there is any such person, or upon the application of a person who holds the next rank in the order of priority if there is no person holding the same rank. In this case, if there is no person holding the same rank, the person who holds the next rank shall be the person with the first rank during that period. (2) A surviving family member whose payment of the compensation pension for surviving family has been suspended pursuant to the provision of the preceding paragraph may apply for cancellation of the suspension of the payment at any time. (3) The provision of Article 16-3, paragraph (3) shall apply mutatis mutandis where the payment of the compensation pension for surviving family has been suspended pursuant to the provision of paragraph (1) or where the suspension of the payment has been cancelled pursuant to the provision of the preceding paragraph. In this case, the term "the month in which the increase or decrease occurred" in paragraph (3) of said Article shall be deemed to be replaced with "the month in which the payment was suspended or the suspension of the payment was cancelled." Article 16-6 (1) A lump sum compensation for surviving family shall be paid in the following cases: (i) where, at the time of the worker's death, there is no surviving family member eligible to receive a compensation pension for surviving family; and (ii) where a person's right to receive the compensation pension for surviving family has been extinguished, and there is no other surviving family member eligible to receive said compensation pension for surviving family and the total amount of the compensation pension for surviving family paid in respect of said worker's death is less than the amount of the lump sum compensation for surviving family that would be paid on the assumption that the situation falls under the case set forth in the preceding item as of the day on which said right is extinguished. (2) When the total amount of a compensation pension for surviving family prescribed in item (ii) of the preceding paragraph is calculated, with regard to the amount of the compensation pension for surviving family paid for a period until July of the fiscal year containing the day of the extinction of the right prescribed in said item (in cases where the month containing the day of the extinction of said right falls on any of the months from April to July, the previous fiscal year; hereinafter the same shall apply in this paragraph), the 17

18 amount shall be calculated according to the amount obtained by multiplying the amount actually paid by the rate specified by the Minister of Health, Labour and Welfare based on the rate obtained by dividing the average salary for the fiscal year before the fiscal year containing the day of the extinction of said right by the average salary for the fiscal year one year before the fiscal year containing the months for which said compensation pension for surviving family was paid (in cases where said months fall on the months from April to July, the fiscal year two years before). Article 16-7 (1) The surviving family members who are eligible to receive a lump sum compensation for surviving family shall be the persons listed in the following items: (i) the worker's spouse; (ii) the worker's children, parents, grandchildren and grandparents who were dependent on the worker's income at the time of his/her death; and (iii) the worker's children, parents, grandchildren and grandparents who do not fall under the preceding item, and the worker's siblings. (2) The order of priority for the surviving family members who are to receive a lump sum compensation for surviving family shall be in accordance with the order set forth in each of the items of the preceding paragraph, and among the persons listed in items (ii) and (iii) of said paragraph, the order set forth in the respective items shall apply. Article 16-8 (1) The amount of a lump sum compensation for surviving family shall be the amounts prescribed in Appended Table 2. (2) The provision of Article 16-3, paragraph (2) shall apply mutatis mutandis to the amount of the lump sum compensation for surviving family. In this case, the term "Appended Table 1" in said paragraph shall be deemed to be replaced with "Appended Table 2". Article 16-9 (1) A person who has intentionally caused the death of a worker shall not be regarded as a surviving family member who is eligible to receive compensation benefits for surviving family. (2) A person who, before the death of a worker, intentionally caused the death of a person who should have held a higher or the same rank in the order of priority as a surviving family member who is eligible to receive a compensation pension for surviving family as a result of said worker's death, shall not be regarded as a surviving family member who is eligible to receive a compensation pension for surviving family. (3) A person who has intentionally caused the death of a surviving family member who is eligible to receive a compensation pension for surviving family 18

19 shall not be regarded as a surviving family member who is eligible to receive a lump sum compensation for surviving family. The same shall apply to a person who, before the death of a worker, intentionally caused the death of a person who should have become a surviving family member eligible to receive a compensation pension for surviving family as a result of said worker's death. (4) When a surviving family member who is eligible to receive a compensation pension for surviving family has intentionally caused the death of another surviving family member who held a higher or the same rank in the order of priority as a surviving family member eligible to receive a compensation pension for surviving family, that surviving family member shall no longer be regarded as a surviving family member who is eligible to receive a compensation pension for surviving family. In this case, if that surviving family member is a person entitled to the right to receive a compensation pension for surviving family, that right shall be extinguished. (5) In the case referred to in the second sentence of the preceding paragraph, the provision of the second sentence of Article 16-4, paragraph (1) shall apply mutatis mutandis. Article 17 The amount of funeral expenses shall be an amount specified by the Minister of Health, Labour and Welfare in consideration of the expenses normally required for funerals. Article 18 (1) The amount of an injury and disease compensation pension shall be as prescribed in Appended Table 1 in accordance with the grades of injury and disease specified by an Ordinance of the Ministry of Health, Labour and Welfare set forth in Article 12-8, paragraph (3), item (ii). (2) Temporary absence from work compensation benefits shall not be paid to a person who receives an injury and disease compensation pension. Article 18-2 Where there has been a change in the degree of the relevant degree of disability of a worker receiving an injury and disease compensation pension, and as a result of such change, that person has come to fall under another grade of injury and disease prescribed in Appended Table 1, the government shall, pursuant to the provisions of an Ordinance of the Ministry of Health, Labour and Welfare, pay the injury and disease compensation pension corresponding to the new grade of injury and disease under which the person now falls, and shall not pay the former injury and disease compensation pension thereafter. Article 19 Where a worker who has suffered an injury or disease resulting from an employment-related cause receives an injury and disease compensation 19