Use of Long-Term Care Insurance Services due to Traffic Accidents (Third-Party Actions)

The use of Long-Term Care Insurance services generally requires users to bear 10% to 30% of the service costs, with the remainder covered by insurance benefits. However, if a user becomes dependent on care due to actions by a third party, such as a traffic accident, or if their level of care needs increases and they utilize Long-Term Care Insurance services, the costs will be borne by the third party responsible for the incident.
The amount equivalent to the insurance benefits for Long-Term Care Insurance services paid by the third party will be temporarily advanced by the Long-Term Care Insurance, and the city will later bill the responsible third party. To bill the responsible party, a report from the affected individual is required. As of April 1, 2016, it has become mandatory for first-class insured individuals aged 65 and over to report to the city, which is the insurer, regarding third-party actions.

About the submitted documents

If a first-class insured person is involved in a traffic accident or other incident that may fall under third-party actions, please consult the Long-Term Care Insurance Section of the Senior Welfare Division promptly. If it falls under third-party actions, the submission of the following related documents will be required.

• Traffic Accident Certificate (issued by the Automobile Safety Driving Center. If you cannot obtain it, please submit a "Reason for Inability to Obtain Traffic Accident Certificate.")
• Copy of the settlement agreement (only if a settlement has been reached.)

• Injury Report Due to Third-Party Actions (PDF 86.2KB)
• Accident Occurrence Report (PDF 105.7KB)
• Consent Form and Memorandum (PDF 85.2KB)
• Affidavit (to be filled out by the offender) (PDF 78.0KB)
• Required Documents (PDF 88.9KB)

• Note: For the traffic accident certificate, notification of injury due to third-party actions, and accident occurrence report, if you have submitted a notification regarding third-party actions under medical insurance, a copy of the relevant notification document is also acceptable.
• Note: For insured persons of the second category aged 40 to under 65, Long-Term Care Insurance services cannot be used if care is needed due to traffic accidents or other third-party actions. (For insured persons of the second category, care certification is only provided for those who require care due to age-related diseases (specified diseases).)