A Back Injury, a Small Employer, and Two Compensation Routes
Yuki works at a 6-employee bakery. While lifting a heavy flour sack during a shift she injures her lower back and is off work for 5 weeks. The bakery has Workers' Compensation Insurance (労災保険) but, being in the 'small business' category, has not joined the separate 特別加入 or a private supplementary plan. Her average daily wage is ¥12,000. Her employer suggests paying her 'out of pocket' the same amount she would get and asks her to sign a paper saying the injury was her own carelessness so the premium record stays clean. She also wonders whether she can claim under the Employees' Pension disability system instead.
1. Explain the Workers' Compensation benefits Yuki is entitled to and whether the employer's proposal is lawful.
Read the worked answer
Entitlement (Workers' Compensation Insurance Act):
- Temporary disability (休業補償給付): 80% of the daily wage (60% basic + 20% special supplement) from the 4th day of absence. Days 1–3 are the employer's obligation under the LSA (average wage × 60%).
- Medical treatment (療養補償給付): full cost of necessary treatment, paid to the provider.
- No-fault principle: Benefits are payable regardless of whether the worker was careless, unless the injury was intentional or due to gross negligence (and even then, benefits are generally still paid).
The employer's proposal is unlawful.
- Signing away statutory benefits is void as against public policy.
- Falsely attributing the injury to the worker's carelessness to suppress a claim could constitute fraud against the insurer and obstruction of a worker's rights.
- The employer cannot substitute a private payment for the statutory scheme or condition employment on the waiver.
Calculation: 5 weeks = 35 days; days 4–35 = 32 days × ¥12,000 × 0.80 ≈ ¥307,200 from the insurer, plus days 1–3 (¥21,600) from the employer.
2. Can Yuki also pursue Employees' Pension disability benefits, and how do the two systems interact?
Read the worked answer
Yes, in principle. Workers' compensation and the Employees' Pension disability benefit are separate systems and may be claimed concurrently; they are not mutually exclusive, though adjustments apply.
Conditions for EP disability benefit:
- The disability must be at the statutory grade (1–3 for the disability basic pension; the disability allowance for lesser grades).
- Insured status and contribution requirements must be met at the time of the initial medical examination.
- A 5-week absence with recovery is unlikely to reach the required grade, so a claim would probably fail on the merits - but the right to apply exists.
Interaction: Where both are payable, the EP disability basic pension is reduced by the amount of the workers' compensation pension (adjustment system). Workers' compensation temporary disability benefits are not offset against EP benefits in the same way, but overlapping periods are reconciled. Yuki should file the workers' compensation claim first; that is the primary route for a temporary work injury.