Submit a notice if you suffer an illness or injury due to the actions of a third party
If you undergo covered medical care for an illness or injury due to a third party, you must notify Sony Health Insurance. Such medical costs are generally borne by the party responsible for the condition. Even if you use your health insurance card for treatment, such costs will ultimately be borne by the party responsible. 


Illnesses and injuries due to actions of third parties

Illnesses and injuries due to actions of third parties refers to all illnesses and injuries caused by other individuals. The most typical example is "traffic accidents."


You are not permitted to negotiate settlements on your own or to withhold notice

Medical costs for an illness or injury due to a third party (such as traffic accidents) are generally borne by the responsible party.

Under the Health Insurance Law, "the right to claim compensation for covered medical care received for an illness or injury due to a third party must be awarded to the health insurance society rather than the insured individual (or dependents)." Sony Health Insurance will seek such compensation on your behalf from the third party's auto liability insurance company.

In addition, the Health Insurance Law stipulates that "if the insured and the responsible party settle for medical costs without notifying the health insurance society, the insurance society is no longer liable to pay benefits." For this reason, such settlements can result in the insured being charged for related medical costs.

Be sure to remember to notify Sony Health Insurance (using a notice of illness or injury due to a third party) and your workplace (using an incident report, since some cases may be covered by Workers' Accident Compensation Insurance).


Procedural Flow from notice submission through settlement
1. First, submit an initial report
This report may be made by telephone. Please contact Sony Health Insurance or the individual in charge of health insurance matters at your workplace.
2. Submit notification documents
In addition to the "Notice of illness or injury due to a third party," submit other required documents such as "Accident certificates (for accidents resulting in injury)" and a "Report of the circumstances of the accident" to the individual in charge of health insurance matters at your workplace.

PDF: Notice of illness or injury due to a third party (example only)

. Report on the status of medical treatment
Report on both inpatient and outpatient treatment.

4. Settlement
The final stage is settlement. Be sure to report your progress to Sony Health Insurance before settlement is complete. (Avoid making settlements with the responsible party on your own.)


Precautions for traffic accidents
1. You cannot switch to covered medical care unless you show your health insurance card.

2. Immediately notify the police and obtain an "Accident certificate,"which is required for requesting insurance benefits.

3. Check the name, address, driver's license number, vehicle type, vehicle owner, registration number, insurance company name, insurance held, and other information from the other person involved in the accident.


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