Be sure to notify the Health Insurance Society

If you suffer an injury or illness caused by a third party, such as a car accident, the third-party victimizer should definitely pay you for medical expenses and compensation for loss of earnings; meanwhile, the victim can receive treatment for the injury under health insurance by submitting a notification to the Health Insurance Society. However, if you receive treatment under health insurance or receive injury and sickness allowance, the right to claim damages for the covered portion will be transferred from you to the Health Insurance Society. This means that the Health Insurance Society will claim damages from the victimizer on behalf of you, the victim, to the extent of benefits paid to you.

In the case of a car accident, the victimizer and the victim often reach an out-of-court settlement to take an easy way, but such settlement conditions could prevent the victim from receiving benefits from the Health Insurance Society.

If you or your family member suffers an illness or injury, or dies, due to an act of a third party, you should immediately notify the Health Insurance Society of such situation through the establishment to which you belong. Doing so will ultimately result in your best interest. If the Health Insurance Society finds out that you suffered a car accident only after seeing a billing statement for your medical expenses sent from a medical care institution, it will be too late to initiate claim procedures.

• *Even those 70 to 74 years of age whose co-payment ratio is 10% because of the special measures will be charged at the 20% co-payment ratio for treatment of an injury or sickness caused by an act of a third party.

If you have been in a traffic accident

1. STEP1Remain calm
   In cases of shock, you may lose the ability to make calm judgments. React as calmly as possible.
2. STEP2Check the identity of the party responsible
   Check matters such as the license plate no., driver's license, and vehicle inspection certificate.
3. STEP3Notify the police
   Be sure to notify the police, no matter how small the accident.
4. STEP4Be cautious about reaching a settlement
   If you waive some of your rights to claim compensation for damages by reaching a settlement with the party responsible, you may be unable to receive the corresponding health insurance benefits. To avoid cases such as inability to use health insurance when you need medical care later for residual effects or other complications, consult with the Health Insurance Society before reaching any settlement.

Injury due to the actions of another party

Examples of “injury or sickness (suffered by an insured person or his/her family member) caused by an act of a third party” are shown below:

1. An injury suffered by an insured person, etc., due to a car accident, such as a contact or collision accident with a third party (another driver)
2. An injury suffered by an insured person, etc., while accompanying the driver of the accident car (this also applies if the accompanying person is a relative of the insured person)
3. An injury suffered by an insured person, etc., due to an act of violence (beating)
4. An injury suffered by an insured person, etc., due to the bite of an animal owned by another person
5. An injury suffered by an insured person, etc., due to an act of a third party (even if the fault ratio of the injured was high)
   (e.g., an accident where the driver crashed his/her car into another car that was parked or stopped, contacted with another car and fell over, crossed the centerline and crashed his/her car into an oncoming car, etc.)

Examples of “self-inflicted accidents (suffered by an insured person or his/her family member)” are as follows:

1. An injury suffered by an insured person, etc., after crashing into a utility pole, guardrail, block wall, etc., due to his/her driving error
2. An injury suffered by an insured person, etc., after letting his/her car fall or overturn, etc., due to his/her driving error
3. An injury suffered by an insured person or his/her family member due to an accident caused solely by him/her except for those listed above
   (e.g., fell from a roof or stairs, fell while walking, etc.)

For an injury or sickness arising from these causes, there may be a limit on all or part of insurance benefits depending on the fault level of the injured.