Workers' Compensation (Rousai Hoken)

What rousai hoken covers

Workers’ accident compensation insurance (労災保険, rousai hoken) is one of Japan’s mandatory employment-based insurance schemes, but unlike health insurance, it is funded entirely by employer premiums. Employees pay no direct premium. The scheme provides no-copayment medical coverage and compensation benefits for:

• Injuries sustained during work duties (業務災害, gyōmu saigai)
• Injuries sustained during commuting to and from work (通勤災害, tsūkin saigai)
• Occupational diseases directly linked to work activities (職業病, shokugyōbyō)

All employers using labor — from large corporations to households employing domestic workers — are required to subscribe to rousai hoken. All employees are automatically covered from the first day of employment. Foreign nationals on any visa status are covered; the scheme makes no distinction by nationality.

How rousai medical coverage works

When an injury is recognized as work-related, the entire cost of medical treatment is covered at 100% through rousai hoken — there is no copayment. Treatment can be obtained at designated rousai hospitals (労災病院, rousai byōin), which are MHLW-affiliated specialized institutions, or at any hospital or clinic that accepts rousai billing.

To access rousai coverage at a medical facility, you need the relevant claim form (療養補償給付請求書, ryōyō hoshō kyūfu seikkyūsho for injury at work, or 療養給付請求書 for commuting accidents). These forms are obtained from your employer or the Labor Standards Inspection Office. The treating facility submits the form to the relevant inspection office.

If you sought initial treatment through regular health insurance before the workplace cause was established, the billing can be corrected retroactively — contact your employer and the treating facility.

Reporting a workplace injury

The first step after a workplace injury is to notify your employer and seek medical treatment. Document the circumstances of the accident — time, location, activity, witnesses — as soon as possible. Your employer is required to report serious workplace accidents to the Labor Standards Inspection Office (労働基準監督署, rōdō kijun kantokusha).

If your employer disputes the work-related cause or does not cooperate with the rousai process, you may apply for rousai recognition directly through the Labor Standards Inspection Office. The office has jurisdiction over workplace accident recognition and benefit disbursement.

Benefits beyond medical care

Rousai hoken provides more than just medical coverage. For workers who are unable to work due to a workplace injury or disease, wage replacement (休業補償給付, kyūgyō hoshō kyūfu) is paid at 80% of the average daily wage from the fourth day of work absence onward (the first three days are compensated by the employer directly under labor standards law).

For permanent disability resulting from a workplace injury, disability compensation (障害補償給付) is paid as either a lump sum or ongoing annuity depending on the severity rating. Death benefits are available to surviving family members. These benefits are processed through the Labor Standards Inspection Office.

Occupational diseases in foreign workers

Foreign workers in Japan are employed in sectors — construction, manufacturing, agriculture, food processing, healthcare, and domestic work — that carry elevated occupational disease risks. Heat stroke during outdoor and factory work, chemical exposure, musculoskeletal disorders from heavy labor, and respiratory conditions from dust or fume exposure are among the recognized occupational diseases under Japan’s standards.

If you develop a health condition that you believe may be related to your work environment or exposures, consult a physician with occupational health expertise (産業医, sangyō-i) and document the workplace conditions in detail. The causal link between work conditions and disease is assessed by MHLW guidelines — the burden of proof is on demonstrating the work connection.

Last reviewed: September 2026