Is it necessary to contract for personal injury insurance?


Personal injury insurance is a very good insurance.

It’s been a while since personal injury insurance was launched in Japan. I was deepy shocked that such compensation was possible at the beginning of the sale, but now most people have contracts. (Over 90% of those who have auto insurance contracts its)

It is very good for policyholders, but for the person in charge of the insurance company, I received a lot of opinions about  the treatment cost, and I remembered having a hard time dealing with it. (In the case of treatment of traffic accidents, patients are often treated without paying for treatment fee , which is called lump-sum payment. )

This insurance is a very good product, and as long as you drive a dangerous vehicle called a car, and more than 500,000 people are involved in personal injury each year due to the flood of cars in the world, you can live a safe life. This is a necessary compensation. It is a miracle product that can receive almost the same amount as personal liability insurance.

Since auto insurance is liability insurance, some people may want to save Auto Insurance Premium because they are okay and young, but insurance premiums are cheaper than vehicle insurance and their body and important things that can not be replaced It is a product that protects your family.

Here, I will explain the problems that I feel through my work experience and the basic knowledge of personal injury insurance.

The basic knowledge of personal injury insurance.

This insurance provides financial support to you and your family from the danger of a traffic accident. Before this insurance was released,when you driver a car ,you are injured, you will only receive a few thousand yen per day from “Passenger Accident Insurance” and “Personal Accident Insurance” .If you are seriously injured for one month in hospital, you cannot work. People who can use paid holiday have no problem, but if they cannot use it, their lives will be poor. You can’t pay the bet for a few thousand yen per day.

Personal injury insurance solves this problem and bears the actual damage.

Which accidents are covered by insurance claims?

It is applicable if it is an accident related to the operation of cars, motorcycles, etc. You are covered whatever use your own car or someone else’s car.

Bicycle accidents can be covered by adding a small amount of insurance premium. I know that if you are pulled by a car that is close to 1.5 tons, you will get seriously injured. However, You are seriously injured even if you are hitted by a bicycle. If you’re walking outside, it’s a wise choice to protect yourself from a bicycle.

Since transportation equipment is used for transportation, it does not apply to roller coasters or boats used in a flowing pool. Even if you make a request, the receptionist will inform you that it is out of compensation and it is over.

Even if you use insurance, the grade does not go down.

Auto insurance is liability insurance. The insurance fee is determined by the risk of driving a car and causing an accident. Once a car causes a traffic accident, it is highly possible that the accident will occur in the following year and later, so the insurance premium will increase.

On the other hand, the risk of driving is not related to being hit by a car while walking, or being injured by a car while stopping, so even if insurance is used, it does not affect insurance premiums for the following year. It is a type of accident insurance that protects the driver and the driver’s family, so it is a good product to sell as a separate item.

  1. You was injured after a collision, but the other vehicle was an uninsured car
  2. You ran into a car while walking but the other vehicle ran away
  3. You are seriously injured in a self-injury accident
  4. Your family was hit by a car while walking

Especially in practice, case 3 is large. Up to now, cases where only a fixed amount of accident insurance such as passenger accident insurance and self-injury accident insurance have come to be rescued. If you are hospitalized for 1 month and take a full rest for 3 months, you will not work for 3 months. If you have this insurance, your actual income will be covered as lost time. Medical expenses are also covered, and you will be injured by yourself, but you will be paid for mental damages (equivalent to a compensation fee for personal liability insurance).

Occasionally, there are people who lodge a complaint against an insurance company that they subscribe to if they are not satisfied with the compensation, but this is not a compensation but a mental damage. Since The company is only calculating mental damages according to the agreement., even if we make a complaint, we will receive the answer as per the terms and conditions. I can understand the feeling of being hit by an uninsured car, but it is an insurance that guarantees the compensation according to the standard according to the agreement. If you are not satisfied with the award, you must take legal action against the perpetrator.

Personal injury insurance calculation method

The basics are the same as for personal liability insurance. There is the difference that the comfort payment (mental damage) is calculated as described in the agreement and there is no room for negotiation. The actual damages will be covered, so you must make a sure claim for what you can claim. If you do have an accident, the insurance company’s payment staff will be able to give you the details, but be sure to check in advance in case of emergency.

Items to be compensated (① to ⑩)

  1. Medical expenses (payment when using public insurance)
  2. Transportation costs related to treatment
  3. Income compensation
  4. Mental damage (injury)
  5. Lost profit (remaining disability)
  6. Mental damage (remaining disability)
  7. Funeral expenses
  8. Lost profit (death)
  9. Mental damage (death)
  10. Other reasonable damage

Damages caused by traffic accidents will be covered. As for loss insurance, the principle is to cover the actual loss, so even if you have two contracts with your family, compensation is limited to the amount of damage you incurred. This is the most important point of income compensation. Care must be taken in the calculation here. The person in charge at the insurance company is also a human, so it is possible to make a mistake. As a contractor, you must also have a solid understanding of yourself.

①How to calculate Medical expenses

Medical expenses require the use of public insurance. This is the first point. In japan,Free medical treatment is allowed about traffic accidents. If the treatment cost is 10,000 yen, 30% of the health insurance will be borne, and the self-pay will be 3,000 yen. Whenever I have a cold, I present my health insurance verification and receive insurance treatment. The hospital will charge the remaining 7,000 yen to the health insurance association for a total of 10,000 yen.

When paying medical expenses as personal compensation, even if you call it free medical treatment and calculate it for 20 yen per point, there is no problem if the perpetrator side responds. Usually, insurance companies pay for this, so personal medical treatment is generally free medical treatment. However, even in the same traffic accident, health insurance is required to be used for personal injury insurance. The insured (injured person) must present a health insurance card and be treated.

In some cases, the use of health insurance may be refused, but medical institutions must accept health insurance if presented. Make sure to explain at the counter that you will pay the medical expenses this time with your health insurance, and pay for your own expenses. The reconstructed money will be returned from the insurance company at a later date. Please be assured to present your health insurance because it is a rare case that you will receive treatment other than public health insurance treatment due to traffic injury.

③Calculation method of income compensation

If you look at the Tokio Marine Covenant, it is stipulated in detail. For salaried workers and office workers, we look at salaried employees. For those who have received a monthly salary of 400,000 yen in the last 3 months, 13,333 yen per day will be the compensation amount. However, even if you’ve earned a lot , it is limited to the equivalent of three months of the previous year’s annual income. It is difficult to understand the words, but in this case, if the annual income is 4 million, the income for 3 months is 1 million, so it is 11,111 yen per day. In this case, 11,111 yen will be the upper limit, no matter how much you earn before. This does not change even if you complain. As long as we conclude an agreement with such a product, we must accept it.

Also, it does not mean that you will be compensated for the rest period. If you are unable to move due to a broken bone, you will be paid because there is no doubt that you will be on leave. The problem is when you are going to rest because of symptoms without objective findings. This is a difficult decision to make, but as with personal compensation, medical investigations are conducted to determine insurance money.

Even with the same income compensation, Sompo Japan’s terms and conditions are slightly different. The actual loss compensation remains the same, but there is no binding of three months’ worth of the previous year’s annual income. The annual income does not increase significantly compared to the previous year, but if you are surely increasing every year, Sompo Japan products are more appropriate. Since it is rare for a salary to be raised by 5% a year, I think that there will be practically no problem even if there is a bond equivalent to the previous 3 months.

If you can’t prove your salary even though it’s a completely different company, the minimum compensation is 5,700 yen. This is due to the amount of liability insurance. I will explain the liability insurance in a separate article. It is a hard insurance to keep in mind that non-life insurance employees work on a desk with a set of regulations for liability liability. If the rules are detailed and the certification falls below the liability standards, the insurance company must make additional payments.

④How to calculate mental damage (injury)

Mental damage is also a point to worry about. How much will I be compensated for the pain I suffered? In the case of personal liability insurance, in addition to the individual circumstances, there is an additional compensation/adjustment. However, there is no personal injury insurance. It is just as per the agreement.

There is a difficult impression when it comes to comfort money, but mental damage (equivalent to comfort money) is easy. All you have to do is calculate according to the terms of the agreement. Specifically, we will calculate according to the terms and conditions. Anyone can do it.

Concrete example) After being hospitalized for 10 days, he is hospitalized for 2 months. Visits are 10 times a month and 20 times.

  1. Hospitalization is 8,400 yen a day, so 10 days worth 84,000 yen
  2. Outpatient visit is JPY 4,200 a day. The total length of hospital stay is 70 days. Calculated at 100% since it is within 90 days
  3. 1 day 4,200 yen x 2 times x 20 days x 100% = 168,000 yen
  4. The total amount of mental damage for hospitalization and outpatient treatment is 252,000 yen.

For open fractures and bruises, the treatment period and frequency of visits are calculated. Is it the same even if it looks like a big injury? I feel sorry, but it is not. A simple calculation method is the best way to accurately calculate and pay for a large number of traffic accidents and injuries.

Even if someone without a doctor’s license looks at the name of the injury or illness on the medical certificate, it is not clear. It’s like a femoral neck fracture and a trochanteric fracture of the femur. It’s easy to understand if it’s a simple injury, but it’s easy to make a mistake when deciding whether an injury is serious or minor. The calculation method that even the contractor can understand is the best. Even if the insurance company is wrong, you can file an objection on the grounds.

Personal injury insurance issues

This image is quoted from Kakaku Com in Japan, but many sites use similar materials. It’s not a mistake, but I think many people might think, “This is a convenient way to get full compensation even if you reduce your costs at your own risk.

If you incur a serious injury of 30 million yen (the amount of money for the case where there is a residual disability) and if you reduce it by 30% to 9 million, you will be in trouble after that. The personal injury that saves this is amazing. But not exactly. What is different?

Where is the maximum amount?

In reality, the amount of personal injury insurance and the amount of damages granted by the perpetrator will not be the same. Usually, the amount of authorization recognized by the perpetrator is often higher. Since it is the perpetrator side, in order to apologize for the victim, the amount of the award is often higher than the personal injury standard.

  1. The perpetrator side certifies the damage of 10 million yen and compensates 80 million yen with 80%
  2. The victim’s personal injury compensation standard is 9.5 million yen.
  3. Many people think that 2 million yen will be paid for 10 million yen-8 million yen as illustrated
  4. Actually, 9.5 million yen-8 million yen will be paid 1.5 million yen.

In case of compensation from a third party (perpetrator), the amount will be deducted and the insurance will be paid. There is a misunderstanding with the illustration here. Of course, personal injury compensation insurance will be covered according to the terms and conditions, so it is not a problem of lack of insurance or such a level. The question is, in this case, can we accept a difference of 500,000 when we get down to ourselves? It’s a misunderstanding, but it’s not refreshing.

The damage amount in a judgment or settlement in a court?

Urthermore, there is a provision in the article of personal injury that if the case is recognized in a lawsuit, the amount shall be regarded as the amount of damage. (I have not confirmed the loss preservation company, but amended each company’s terms and conditions after the Supreme Court issued the theory of difference in litigation standards.) I thought that insurance is a product according to the terms of the agreement, but if a lawsuit comes, the amount is Will change.The power of low is great.

The insurance money of the person who was added the amount of damage by litigation will be borne by the insurance premiums of all the contractors. Since not all people try the case, fairness among contractors will be a concern, but since all contractors have the right to try, we must accept it.

Although there are current issues, it is better to contract for personal injury insurance because the benefits of supplementing it are greater. The number of cars with a rear-end collision prevention function is increasing, and the number of car accidents is decreasing, but many accidents still occur and there is a risk of walking. Personal injury insurance is insurance that can protect you and your family at a small cost.