Use of long-term care insurance services due to traffic accidents, etc. (third-party actions)

As a general rule, the user bears 10% to 30% of the service cost for the use of long-term care insurance services, and the rest is borne by the insurance benefits of the long-term care insurance. However, if the need for long-term care is caused by an act of a third party, such as a traffic accident, or if the need for long-term care becomes severe and long-term care insurance services are used, the third party who is the assailant shall bear the costs. becomes.
The amount equivalent to insurance benefits for long-term care insurance service costs borne by a third party will be temporarily paid by long-term care insurance, and the city will claim the assailant later. In order for the city to make a claim against the perpetrator, notification from the target person is required. From April 1, 2016, first insured persons aged 65 or older are obliged to report to the city, which is the insurer, regarding acts of a third party.

If there is a possibility that a first insured person may fall under the act of a third party due to a traffic accident, etc., please consult with the Elderly Welfare Section Nursing Care Insurance Section immediately. If it falls under the act of a third party, it is necessary to submit the following related documents.

・Traffic Accident Certificate (issued by the Safe Driving Center. If you cannot obtain one, please submit a “Statement of Reasons for Not Obtaining a Traffic Accident Certificate.”)
・A copy of the settlement agreement (only if a settlement is reached)

Note: Regarding traffic accident certificates, reports of injuries and illnesses caused by third party actions, and accident occurrence reports, if you have made a report on third party actions for medical insurance, a copy of the relevant notification form is acceptable.
Note: Category 2 insured persons between the ages of 40 and 65 who require nursing care due to traffic accidents, etc. (acts of a third party) are not eligible for long-term care insurance services. (This is because Category 2 insured persons are certified as needing long-term care only when they require long-term care due to an age-related disease (specific disease).)