Workers' compensation in Japan: what SSW workers need to know about rōsai hoken

Japan has two insurance systems that cover medical expenses, and they apply to different situations. Your regular health insurance (健康保険, kenkō hoken or 国民健康保険, kokumin kenkō hoken) covers illnesses and injuries that happen outside of work — colds, routine checkups, accidents in your personal time. You pay a co-payment of around 30% of medical costs.

Workers' compensation insurance (労災保険, rōsai hoken) is administered by the Ministry of Health, Labour and Welfare and covers injuries and illnesses caused by work or by commuting to and from work. When rōsai applies, your employer's insurance pays 100% of medical costs — you pay nothing out of pocket. It also pays a portion of your lost wages if you cannot work while recovering.

Rōsai hoken is funded entirely by employers. Workers pay nothing toward it, and you cannot be enrolled or unenrolled at your own request. Every business in Japan is legally required to enroll all employees — including part-time workers, temporary workers, and foreign workers on SSW visas. There is no minimum employment period before coverage begins: you are covered from your first day at work.

Because rōsai claims create a record of workplace accidents, some employers prefer that injured workers use their regular health insurance instead — avoiding an increase in the employer's insurance premium and avoiding scrutiny of workplace safety conditions. Directing you to use regular health insurance for a work injury is illegal. It means you pay a 30% co-payment you should not have to pay, and you lose access to wage-replacement benefits and other rōsai compensations that regular health insurance does not provide.

Work injuries (業務災害, gyōmu saigai): any injury, illness, or death that occurs while performing work duties or as a direct result of work conditions. This includes: cuts and burns from food processing equipment, crush or impact injuries from manufacturing machinery, fall injuries on construction or farm sites, heat stroke during outdoor agricultural work in summer, injuries from repetitive motion over time (such as wrist or shoulder injuries from assembly line work), and illnesses caused by chemical exposure or poor ventilation.

Commuting injuries (通勤災害, tsūkin saigai): injuries that occur while traveling between your home and your workplace on a reasonable and direct route. This includes road accidents, train injuries, and falls. Note: if you make a significant detour for personal reasons (stopping at a shop, visiting a friend) during your commute, the portion of the journey after the detour may no longer qualify as a commuting injury. Going directly between your dormitory and your workplace counts.

Occupational diseases (職業病, shokugyō-byō): illnesses that develop over time as a result of work conditions, such as respiratory conditions from dust or fume exposure, skin conditions from repeated chemical contact, or hearing loss from sustained loud machinery. These are harder to claim but are covered under rōsai hoken if a causal link to work conditions can be established.

What is NOT covered: illness or injury unrelated to your work or commute (getting sick over a weekend, a fall in your dormitory room during off-hours, a sports injury on your day off). For these, use your regular health insurance card.

Medical expenses (療養補償給付, ryōyō hoshō kyūfu): 100% of medical treatment costs at approved medical facilities. You pay nothing. If you accidentally used your regular health insurance card at a clinic for a work injury, you can switch to rōsai coverage afterward — ask the clinic to reprocess the claim under rōsai, or ask the Labor Standards Inspection Office for guidance.

Wage replacement during recovery (休業補償給付, kyūgyō hoshō kyūfu): if your injury prevents you from working for four or more days, rōsai pays 60% of your average daily wage starting from the fourth day of absence. An additional supplement (休業特別支給金) adds another 20%, bringing total replacement to approximately 80% of your average daily wage. The first three days of absence are covered by your employer directly — they must pay 60% of your wage for those days under the Labor Standards Act.

Disability compensation (障害補償給付, shōgai hoshō kyūfu): if your injury results in a lasting disability (from a minor scar affecting appearance to complete loss of a limb or function), rōsai pays either a lump sum or an ongoing pension depending on the severity level. Japan rates disability into 14 levels (grades 1–14), with grade 1 being the most severe.

Death benefits (遺族補償給付, izoku hoshō kyūfu): if a work injury or disease causes a worker's death, rōsai provides ongoing pension payments to surviving dependants or a lump sum. This is not relevant to most situations, but it is important to know that your family has legal protections if the worst happens.

Funeral expenses and more: rōsai also covers funeral costs in fatal cases, and certain rehabilitation and re-employment assistance programs for seriously injured workers. The full scope of rōsai benefits is broader than most workers realize.

Step 1 — Get medical treatment first. If you are injured, your immediate priority is treatment. Go to a medical facility. If possible, go to a 労災指定医療機関 (rōsai shitei iryō kikan — a hospital or clinic approved for workers' compensation treatment). At intake, tell the reception staff 「労災です」(rōsai desu — 'this is a workers' comp case'). Do not hand over your regular health insurance card for a work injury.

Step 2 — Notify your employer. Tell your employer that you were injured at work as soon as possible. They are required to report work-related injuries to the Labor Standards Inspection Office (labor inspector) — this is not optional. Ask your employer to start the rōsai paperwork. In most workplaces, HR or the safety department handles this.

Step 3 — Fill out the claim form. For medical expense coverage, the form is 療養補償給付たる療養の給付請求書 (Form 5 for workplace injuries, Form 16-3 for commuting injuries). For wage replacement, it is 休業補償給付支給請求書 (Form 8 for workplace, Form 16-6 for commuting). Your employer fills in part of these forms (their section covers the confirmation of the accident). You fill in the rest and submit to the Labor Standards Inspection Office in your area, or the clinic submits directly if it is a rōsai-approved facility.

Step 4 — If your employer refuses to cooperate. You can file a rōsai claim independently without your employer's cooperation. Go to the Labor Standards Inspection Office (労働基準監督署, rōdō kijun kantokusho) in your area and explain the situation. They can initiate the claim process. Bring your own records of the incident: photos, dates, notes about what happened. The inspector can require your employer to provide their portion of the paperwork.

Important: there are time limits on rōsai claims. Medical expense claims must be filed within two years of the date of treatment. Wage replacement claims must be filed within two years of the date you were absent from work. Disability claims must be filed within five years of the date your condition stabilized. Do not assume it is too late — check with the Labor Standards Inspection Office.

Employers pay into rōsai hoken as a percentage of their total wage bill (the rate varies by industry — higher for more dangerous industries like construction, lower for office work). When a workplace injury is officially recorded, it can trigger an inspection of the workplace's safety conditions and may increase the employer's rōsai premium in subsequent years.

This creates an incentive for some employers to pressure injured workers into not filing rōsai claims. Common tactics include: telling the worker the injury was minor and offering to pay the medical bill out of pocket personally; telling the worker to use their health insurance card 'for now'; saying that filing rōsai will cause problems for the company or affect the worker's employment status; or simply not mentioning rōsai at all and hoping the worker does not ask.

None of these pressures are legally valid. Your right to file a rōsai claim exists independently of your employer's preferences. Filing a rōsai claim cannot legally be used as grounds for dismissal or retaliation — Article 19 of the Labor Standards Act explicitly prohibits dismissing a worker during the period of rōsai treatment and for 30 days afterward.

If you have already used your regular health insurance for a work injury — perhaps because you did not know better — you can retrospectively apply for rōsai coverage. You will need to return any benefits paid by your regular health insurer, and rōsai will then cover 100% of the costs. Ask the Labor Standards Inspection Office for the correction procedure.

Being told to use your health insurance card for a clear work injury: if you cut yourself on processing equipment, fall from an agricultural vehicle, or suffer a burn in a commercial kitchen, and your employer tells you to go to the clinic with your regular health insurance card — this is a red flag. Ask explicitly whether rōsai applies.

Being offered cash to cover your co-payment: some employers offer to reimburse your 30% health insurance co-payment in cash rather than file a proper rōsai claim. This keeps the injury off the books. Accept the reimbursement if you need the money, but also pursue the rōsai claim — you are still entitled to wage replacement and other benefits the cash offer does not cover.

Being pressured not to report the injury at all: statements like 'it's just a small cut, don't make a fuss' or 'it's better not to report this, it will cause problems' are attempts to suppress a legally required report. Employers are required by law to report workplace injuries that result in four or more days of absence to the Labor Standards Inspection Office. Concealing reportable accidents is a criminal offense under the Industrial Safety and Health Act.

Your injury is described as a personal health issue rather than a workplace accident: if your employer classifies an injury that happened at work as an existing condition, a personal illness, or an off-site accident — this is misclassification. You can dispute this by filing independently with the Labor Standards Inspection Office with your own account of events.

No mention of support or rōsai when you are injured: in a well-run workplace, your supervisor or HR should immediately tell you that rōsai applies and walk you through the process. If nobody mentions it and you are left to figure it out alone, you are not being properly supported. Seek information from the Labor Standards Inspection Office or the Foreign Workers' Consultation Center (外国人労働者相談センター) in your prefecture.

Labor Standards Inspection Office (労働基準監督署, rōdō kijun kantokusho): every city and major town has one. This is the primary authority for rōsai claims, workplace safety, and labor law violations. Inspectors can investigate employers, require them to file paperwork, and assess back-benefits owed to workers. You can walk in or contact by phone. Services are free.

Foreign Workers' Consultation Center (外国人労働者相談センター): each prefecture operates one. Can provide advice in multiple languages (Vietnamese, Indonesian, Thai, English, and others depending on location) on how to file rōsai claims and what you are entitled to. A good first stop if you are uncertain what to do.

Japan Legal Support Center — Houterasu (法テラス): provides free legal consultation and can connect you with affordable legal aid for more serious disputes. Available in English and some other languages. Accessible by phone.

Supportive sending organizations and employer-side support personnel (支援担当者, shien tantōsha): your employer is required to designate a support person for SSW workers in their company. This person's role includes helping you navigate administrative matters in Japan. A genuine support contact should help you access rōsai coverage, not discourage you from using it.